I had my televisit with Dr. Hepworth.
He was very nice and gave me more information about my situation in 15 minutes than anyone else in 5 years.
The bad news. My case is one of the worst. The left styloid is fractured and on the artery. The right side is similar but not as bad. He found a spinal CSF leak in my neck. He suspects J may have another in my mid back.
I also have nutcracker syndrome.
He has asked I travel there for testing as soo. As he can get me in, followed by surgery on left side.
I am praying this is the beginning of help for me. I can t stand much more.
I’m so pleased that he is able to help you, and that he was able to identify different issues with your neck. I pray too that he gets you in asap for testing and surgery, and for you to keep strong while you wait.
@harrisonboy - I’m so glad you’ve decided to make the trip to CO, even if it’s difficult, it will be worthwhile for getting more timely care from Dr. Hepworth. Do drop by his office prior to your scan appts on Monday to schedule a scan follow-up appt while you’re in Denver this trip. Explain your hardship getting to Denver & emphasize your need to see him while you’re in town if they put you off. Be proactive in advocating for yourself.
I am praying for God to order your steps & provide the medical support you need while in Denver & for your safe travels there & back home.
I will… Can you send me the link again for the protocols he uses for the Ultrasound and CT Venogram? I could not locate them.
I had another question. I have developed tremors from either ES Nutcracker or CSF leak, who knows, so do you know if they allow you to take something to calm those for the scans? I have some Ativan and Phenergan that I have used before.
I can’t tell you how much I appreciate your help and support. As I have said, this will be a miracle If I can just make it to the scan. I need to be in an ER today…
@harrisonboy - I don’t know about taking meds prior to the scans as they could affect the outcome of the scans. You’d need to ask Dr. Hepworth’s ofc about this. I suggest doing it through info@denversinuscare.com to get the quickest answer since their phone system seems to be down. Otherwise, you can try calling Health Images as they can also probably say yay or nay to the meds.
Here’s the link to the protocol, but Health Images staff are very familiar with it as that’s the place Dr. Hepworth always sends his patients for a jugular US. 2024_02_20 Protocol Ultrasound Hepworth 1.pdf (783.4 KB)
@Isaiah_40_31 Is this the most updated Hepworth US protocol? I have one PDF that indicates:
Test: Bilateral upper extremity venous ultrasound
Protocol: Intra-jugular velocity is checked bilaterally at the following sites:
Proximal/Central
At the SCM/OHM narrowest segment
At the carotid bulb
At the level of C1
At the level of the foramen or as distally as possible. Difficult to regularly see the styloid process, possible related to a drop out issue fro bone shadowing once at the base of the skull.
But the document you just posted is more detailed. I’m assuming that is the most up to date one?
Also does anyone know if our personal doctor can order Hepworth’s US protocol to the Vascular Institute of the Rockies since it’s impossible to reach Hepworth’s office?
I can’t get them to call me back either.
I will tell what I have run into with orders at a teaching hospital. I wanted dynamic testing. My GP tried to get it. A supervisor in Radiology told him they had no protocol and to send me to Cleveland Clinic.
When I had my CTA done a “Fellow” or “Resident” (I can’t remember) in neurovascular surgery told me his department could often get radiology to do what they wanted. They just had to explain it. I suppose similar to Hepworth telling his place what he wants.
The trick is getting it accomplished. Since Neurovascular told me I don’t have a problem which is ridiculous given what the neuroradiologist said I hit a brick wall.
So the answer is that it is possible but your chances of success seem very low to me.
I would love to hear how many people here were able to get the protocol done in their own location.
Oh I just meant having your local provider order Hepworth’s US protocol and have it done at the vascular institute of the Rockies where he sends people for scans.
Oh yeah that is a different story. But then you are talking about State issues and not being able to practice in that State if the Doctor is not in Colorado. Interesting question.
Doctors can order imaging across state lines, that’s not an issue. I’m just not sure if Hepworth’s protocol is so specialized that only he can order it or can anyone if they have the right information on how to order it.
Your doctor should be able to order Hepworth’s protocol (maybe by calling it Dr. Hepworths IJV US protocol), but Dr. Hepworth usually uses Health Images in Cherry Creek to do the jugular ultrasounds he orders. There are a couple of techs there who are very familiar with it. It doesn’t say this in the description, but the valsalva maneuver is also used during the US i.e. at various times during the US, the tech will tell the patient to hold his/her breath & put pressure into the neck. I don’t know the reason for this, but perhaps it helps exhibit the velocity rates of blood flow at those points more clearly.
