In Canada, feeling hopeless

I am hoping for some help in this.

Fist I am wondering why all of a sudden in the last year I have many symptoms, when I didn’t previously. In 2021 I was diagnosed with ES, but since I had no symptoms there was no treatment plan started. Then about 5 months ago - BAM, one day literally

I woke up almost a different person.

-Pain when turning my head, feels like something gets caught behind my ear at the base of skull, and then vision goes weird for a few seconds.
-TIA-like episodes randomly (dizzy, heart palpitations, vision issues, numb right side, headache, followed by debilitating fatigue). Dr. did the ct to see if I was having strokes, but nothing.
-panicky like moments, here and there - randomly. But I’m not panicking about anything.
-random eye ball pain, like sharp stabbing.
-Temple and behind ear headaches that last days
-a lot of pain under my jaw/chin area, I think its called submandibular area? Like something is jabbing in there on both sides. I also can feel nobs on either side of my tonsilar fossa area, and when I press it hurts all the way up to my ear.
-Ear pain, like a loud thudding going really fast, and it hurts (like a gunshot going off in my ear that lasts about 30 seconds or so)…it hurts a lot. I think it might be ear spasm?
-DEBILITATING BRAIN FOG, I mean I cannot take it, I feel like Im in a different reality and not really here most of the time. Like life is in slow motion, and Im not really part of it (or like you feel when you have had like 4-5 drinks). This is the worst feeling.
-Lately, the last week or so, I have had pain at the front of neck in the bone near where the adams apple might be, and it feels like someone is pressing it, or choking me. And it gets worse when I swallow like windpipe is getting crushed. This started when I choked on my coffee and couldn’t stop coughing - then I had neck pain and some blood in my saliva.
-I have issues swallowing, like my brain isn’t realizing sometimes that I want it to swallow.
-constant ringhing in the ears, sometimes it goes SUPER loud and then I cannot hear anything else but the ringing.
-DIZZINESS or vertigo, sometimes it lasts days on end. I actually fell down the stairs 2 weeks ago due to it.
-started getting jaw pain that feels more like a ‘pucker’ feeling when you eat something sour, followed by release of saliva. If that makes sense.

My Dr. did a full workup and CT scan of the brain. Nothing found at all, other than high aldosterone. I have been retested and now its normal. I then remembered about the ES, and told my family Dr. I had a look at the ct images and ran it thought chatgpt who said that the images we do have clearly see how the calcification and between all images estimates them to be 5.5cm +. But she didn’t have them look at the neck area at all, for some reason. Just the brain so we don’t get a clear look at ALL the head and neck.

I am in Canada, and currently waiting to be referred to Dr. Fung in London ON. I am not holding out much hope as in Canada the process for this is bleak. I cannot afford to go to the US for surgery, as I cannot afford $50K.

Also I feel lately I can feel the bones when I move certain ways, like I can feel them in that area under my chin and I have a couple spots that feel like swollen glands but arent (I have had an ultrasound the other day). It hurts.

I feel that this is ruling my life, and I just want to feel better. I have attached my pan from dentist, but the one from 2021 looks more dramatic for some reason, thinking maybe the angle and just cannot see all the bone past other bones?

Is there any way to tell if there is compression anywhere in ct?

Any help or advice or any tips would be great appreciated. Feeling really defeated. Attached are the images I used to show my family Dr so she would refer me to a head and neck surgeon.

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@theresa - I’m very sorry your symptoms escalated suddenly. That’s happened to a number of our members. It’s been several years since your initial diagnosis & once styloids begin elongating, the process usually continues so it’s likely your styloids finally got long enough they’re causing significant irritation & possibly vascular compression in your neck. Some of your symptoms sound like carotid compression whereas others sound like they could be from internal jugular vein compression.

I’ve annotated your first & second images. In the first one, the styloids are causing obvious vascular compression. I can’t tell which vertebra is in that image, but if it’s C1, then what I’ve marked are the IJVs. A few of our members have both IJV & ICA/ECA compression which causes very uncomfy symptoms like you have.

The doctors below are on our Doctors List are familiar with ES & may be more helpful for you than the doctor you’re waiting to see.

•Dr Eric Monteiro, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto 416-586- 4800 (possibly treats ES, he has done a surgery with Dr Ian Witterick, who no longer does ES surgery.) Otolaryngology Care Team | Sinai Health
•Dr Michael Gupta, Hamilton, ON. https://surgery.mcmaster.ca/bio/michael-gupta
•Dr. Hodaie, via St. Michael’s or Toronto Western ENT departments/clinics , Mojgan Hodaie | Department of Surgery


I have circled your styloids in orange. They are very long.

I’ve marked what look to be flattened IJVs if this slice is at C1

Humble apologies, that I accidentally removed the first image I annotated from your post & couldn’t put it back in w/o the annotation.

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I’ sorry that things have worsened suddenly, it’s weird but it can happen! I agree with what @Isaiah_40_31 has said about your imaging, and going by your symptoms too it sounds as if there’s vascular involvement. I had bilateral IJV compression, & get the feeling of being constantly drunk!
Some members have recently been referred to Dr. Viallet HSC (Winnipeg), I don’t know if that’s an option at all?
We have a private message thread as well for Canadian members so I’ve sent you an invite to that, I guess as you joined a while back & haven’t been on for a while you were missed off that!

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@Isaiah_40_31 Thank you so much Isaiah for your amazing reply. You have helped a lot - and were able to show me what I have instinctively knew (that I have compression). I can confirm that is the c1 slice. I wish I could get an angiogram to know how much compression there is - but my Dr. will not send me for one.

It’s really escalating quickly in the last few weeks, and I think I will take your advice and see if the other Dr.s you mentioned can help. I was in such a state last night (massive headache, with pain focused in jaw/temple/behind ear and bad pain under my jaw like something stabbing it), that I was looking into Dr. Kamran in Turkey as he seems well esteemed and the surgery is a lot more affordable. If it comes to it, I will save and make that journey (there is no way I could afford the US doctors)!. I will continue to fight for myself.

Is there any real possibility of this becoming dangerous, as in if I wait too long something bad could happen like TIA etc? I’m worried about that. And also if there is compression do they prioritize it at all? Sometimes I am genuinely scared with how I feel.

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@Jules Thank you for your reply Jules! I think that I may have had symptoms all long since I was diagnosed in 2021, but didn’t connect them at all (during that time I was diagnosed with hemi plegic migraines, and fibromyalgia but suspect I may not have either!). The drunk feeling is horrible, I actually fell down the stairs 2 weeks ago due to the dizzy feeling and just ‘out of it’ feeling which is ALL the time and not just sometimes. Thank you for the invite to the Canadian group, I will join.

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Oh I forgot to add a VERY big symptom I get, but I am not sure if it’s related at all. I have phases, or significant amounts of time (like 1-3 weeks) where I have extreme weakness in my limbs - arms and legs, as well as almost numbness in my right side, or a ‘burning’ sensation. Nobody knows why - this is why they diagnosed me with fibro, but I don’t think I have that. Perhaps its related to this all along?

Also vein pain!! OMG I have so many symptoms that I keep forgetting them all. Vein pain is horrible like stinging pain in the vein on my neck.

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Weakness/numbness like you’re describing can come from carotid artery compression or irritation caused by your styloid(s) or the greater horn(s) of your hyoid bone. I know of one case where the patient’s IJVs were compressing the carotids. Crazy how our own vascular systems can fight among themselves!

If you have vascular pain in your neck, it’s more likely to be your carotid artery(ies) as the veins don’t normally hurt but the carotids can cause significant neck pain if they’re being irritated or compressed. The jugulars pose no risk of causing TIAs or strokes but the carotids do.

I don’t know that patients with suspected vascular compression issues get priority over others. Perhaps if you had a CT scan w/ contrast that definitively showed you have compression, it could help, but then you need your PCP to refer you for that.

An angiogram really isn’t necessary to check degree of compression if the compression is visible in a CT w/ contrast, CTA/CTV, or MRA/MRV & the patient is displaying symptoms of vascular compression. Angiograms come with significant risks themselves w/ the top problem being they can cause a stroke.

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Thank you @Isaiah_40_31 I appreciate your thoughts!

I was wondering if you could look at this axial bone CT if c1 / ct level . Grok says this

“In anatomical terms, it sits at the C1–C2 level — specifically:

Just below the tip of the dens (the upward spike of C2 you see in the center)

Right at the lateral mass of C1 and the transverse processes of C1

Exactly where the internal carotid arteries and internal jugular veins make their sharp turn around the skull base to enter the carotid canal and jugular foramen

That’s precisely why this slice is so devastating:

your 70 mm / 66 mm styloids have grown so long and thick that they reach all the way down to C1 and are now sandwiching both carotids and both jugulars against the C1 transverse process — the classic “nutcracker” mechanism of severe vascular Eagle syndrome.

Right side of the screen (patient’s left) → the thick white bony spike is your right styloid (the 70 mm, 8.3 mm-thick monster).

It is literally wrapped around the right internal carotid artery (the round black circle just medial to it) and flattening the right internal jugular vein (the larger dark area that should be wide open but is almost invisible here — that’s your near-total occlusion).

Left side of the screen (patient’s right) → the left styloid is doing the same thing, just a bit less aggressively:

It’s pushing the left internal carotid artery inward and narrowing it by ~40–45 %

It’s also squeezing the left internal jugular vein (still has a tiny slit of lumen, but severely compressed).

This single image shows four major vessels simultaneously compressed by two giant styloids — the textbook definition of severe bilateral vascular Eagle syndrome.”

I was wondering if you let me know if you concur or if you think Grok is being dramatic :joy:

Thank you so much for all your help! I’m just trying to figure this all out.

Also this one shows throat compression?

I’m sorry to say but I don’t know what I’m looking at in the two images you just posted. They don’t look like other axial slices I’ve seen that are in the C1 area.

A CT w/ contrast would be the best way to get a more accurate diagnosis. Ask your doctor to please request that it be done dynamically & include some 3D images.

I’d say based on the symptoms you have that what GROK said could be accurate i.e. you have both IJV & ICA compression, but perhaps it’s been a bit dramatized.

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I can’t see anything to be able to tell in those images either, @TML has posted his images to show which one shows the styloids, IJVs & carotids best, if you have any more images like this:

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Hi, there! I’m so sorry to hear how debilitating this is become for you! I have had some similar sudden exacerbations as well, which have resulted in my getting a very quick referral to a specialist in Toronto. I noticed their information is not included on the list above. This might be your best bet for getting the process going. I recommend getting a referral immediately to Dr. Vittor Pereira in Toronto and following up by calling their office to discuss the urgency of the situation. They can make the process speedy if needed. I would say you would need it to be speedy! They will do a CTV scan at the hospital there and you can have the results immediately and go from there to see the doctor. They can set it up for the same day. If anybody gives pushback on that, I would be emphatic about it. They absolutely can make it happen! They did it for me. Here is their contact information:

Neurovascular Program

Dept. of Trauma & Neurosurgery

Unity Health Toronto – St. Michael’s Hospital Site, 30 Bond Street

Dr. Vittor Pereira 416-360-4000 ext 7113

Imaging Dept (They will want a scan with contrast done on site.)

(416)864-5656

I hope this helps! Good luck! These folks should get the ball rolling for better and more immediate care. :folded_hands:t2:

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I think Grok has gone coo coo :smiley: - Sorry, Im not sure what that is - it just pulled it out and said it was very dramatic so it freaked me out.

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@jules @Isaiah_40_31 @TML These are the lowest this ct goes - as he was scanning the brain and not my neck. I need a new one, but my Dr. will not send me for one.

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Thank you @Deanna I have called and left them a message. I am going to ask my Dr. to refer me to them.

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Thank you for checking on your imaging for other views, @theresa. It still looks to me like your IJVs could be compressed bilaterally.

Dr. Pereira has been mentioned on our forum among our CA members many times but he doesn’t do styloidectomies so we haven’t added him to our Doctors List.

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@Isaiah_40_31 thank you for taking a look! A question about the cartoid artery. Is that not seen in these scans or is that at a different level?

I emailed Dr. Kamran as well to see his thoughts. After calling all around today they still haven’t even looked at my referral at Dr Fungs office. I also called a Dr. In Hamilton today. :pensive_face:

Your carotid arteries don’t appear to be visible in any of the images you posted.

Here’s an image that @TML annotated for @Hamela so you can see where things are at the level of C1:

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It looks like your IJVs are pretty compressed both sides on the new images you posted, but it could be there’s some muscular compression too, the way they’re flattened. CTs with contrast can be timed to take in the arterial phase as the contrast dye goes through or the venous stage, so it doesn’t look like images of your arteries were taken.
I’m sorry that you’re not hearing back from any doctors, I hope they get back to you soon :hugs:

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Thank you so much for your reply. It is amazing to be able to see this on a normal ct. I am allergic to IPV dye, so not sure I can get contrast imaging. I will ask when I eventually am able to see someone.

I reached out to Dr. Gupta out of Hamilton and he no longer does this surgery they just called me to let me know. Also Dr. Witterick in Toronto no longer does this surgery. Just in case others are wondering.

I also heard back from Dr. Kamran Aghayev from Turkey, and he was so fast to respond to me. He went back and forth to get my symptoms and images, but said I would require full CT of the neck in order for him to advise any further. He suggested coming to Turkey to have this done ASAP, as he said I would be diagnosed and treated within days. If only I had the money for that!

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I’m sorry again that Dr. Kamran is out of reach for you financially at the moment. We knew Dr. Witterick was no longer doing ES surgeries & had taken him off our Doctors List, but I’m sorry to hear that Dr. Gupta has stopped doing ES surgeries.

These are all the doctors we have listed for CA in case you can travel out of your province for ES care:
•Dr Sayed, Manitoba.
Suhail Sayed MD, FACS | Department of Otolaryngology Head & Neck Surgery
•Dr. Dan O’Connell, 1E4 WMC, University of Alberta Hospital (May no longer be doing ES surgeries)
8440 112 Street, Edmonton, AB, 780-407-4598, https://headandneckclinic.ca/page.php?id=1#4
•Dr. Viallet at HSC in Winnipeg
•Dr Eric Monteiro, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto 416-586- 4800 (possibly treat ES, he has done a surgery with Dr Ian Witterick, who no longer does ES surgery.) Otolaryngology Care Team | Sinai Health
•Victoria General Hospital, Halifax, NS (one member had surgery here)
•Dr Stuart Richardson, Spring Garden Rd, Halifax, NS (Dentist, mentioned by a member back in 2014, diagnosed them and would do surgery, don’t know his experience.) https://www.ratemds.com/doctor-ratings/3540252/Dr-Stuart-Richardson-Halifax-NS.html
•Dr Mori, University of British Columbia (call first, told one member he doesn’t do surgery now), Tyler Mori, MD, FRCSC | Department of Surgery
•Dr Don Anderson - 3030 Lincoln Ave Unit 212, Coquitlam, BC V3B 6B4, 1-604-941-9191 (Does only shorten the styloids a bit though, so may not be enough to resolve symptoms)
•Dr Rick Jaggi, Saskatoon, SK, https://www.facecosmeticsurgery.ca
•Dr Khalid (Kal) Ansari, Edmonton, AB - Dr. Kal Ansari - Doctor/Clinic/Service Provider Profile - Medicard
•Dr. Russ Murphy, Saskatoon, SK - R. Murphy - College of Medicine - Medicine | University of Saskatchewan
•Dr. Norbert Viallet, Health Sciences Centre in Winnipeg, Manitoba, https://www.zoominfo.com/p/Norbert-Viallet/1567245874
•Dr. Hodaie, via St. Michael’s or Toronto Western ENT departments/clinics , Mojgan Hodaie | Department of Surgery
•Dr Kulbaba, Radiologist, ARC - MSK Ultrasound - Atlas Radiology Consultants will give opinions on CT scans and performs neck ultrasound
•Dr. Jonathan R. B. Trites - Halifax, Nova Scotia - Does ES & Hyoid Bone Syndrome surgeries - Jonathan R.B. Trites - Division of Otolaryngology–Head & Neck Surgery - Dalhousie University

  • Dr. Jason Foulds, a vascular surgeon at Vancouver General Hospital. He will treat VES of the carotid artery, but might not treat IJV compression.
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