New Member Here! Vascular Symptoms, Chasing Neurosurgeons, and a Breathing Paradox

[Tusker]

Hi everyone,

I just joined here, and I wanted to share my story, where I am currently stuck in the medical maze, and ask a few specific questions.

The Symptoms. My symptoms started very abruptly around March 2024, following three 50k IU megadoses of vitamin D2. The most debilitating symptom is easily the head pressure. Lightheadedness, brain fog, sleep issues, anxiety, and neck pain are all issues too. I sometimes get a hot sensation and my ears turn bright red. (AI suggests this is likely related to Vascular ES). I do have a 10-year history of syncope (fainting). This predates everything else, so it might be unrelated, but it’s part of my history.

When I say they started abruptly, I mean I had none of these symptoms in any severity. I had never experienced them before. (Excluding the syncope. I have those about once a year.)

The Timeline & Discovery. For most of 2024, I was chasing ghosts. I had a syncope episode in Jan 2024, found my Vitamin D was critically low, and started megadoses. Shortly after, the intense head pressure and anxiety crashed in. I went to the ER convinced I had a brain tumor. They gave me a statin and sent me home.

Later, a scan found a 7mm Chiari Malformation, but neurosurgery dismissed it as asymptomatic. I spent a year in physical therapy for “cervical stenosis” without much relief.

I finally turned to AI. In late 2025, after feeding it my entire medical file, it suggested Vascular Eagle Syndrome. I went to my dentist for a 3D CBCT scan. Interestingly, my styloids are not clinically elongated (they are under 3cm), but the geometry relative to the atlas (C1) seems to be the issue.

Current Status: The Doctor Hunt I’ve been aggressive in reaching out to specialists:

• Imaging: I successfully advocated for a Dynamic CT Venogram on Jan 28, 2026.

• Dr. Aghayev (Istanbul): He was the first to respond. He sent me a video analysis noting that, despite the normal length, the styloid is touching the C1 vertebrae on the left and has only a 3mm gap on the right.

• Barrow (Phoenix): Their Second Opinion program reviewed my case and recommended a Venogram with Manometry to measure pressure gradients.

• Dr. Costantino (NY): I have an appointment scheduled for the end of April.

• Dr. Cognetti (Philly): Tried to inquire, but I haven’t been able to reach his office. I was told ES surgeries are booked out until next summer for him anyway, so I don’t think I will pursue him.

• UCSF: Currently working on a referral for the Manometry.

• Dr. Nakaji (AZ): He has my scans, and I am waiting for his feedback.

• Local Option: I am also trying to get the Venogram/Manometry done locally, just to speed up the data gathering.

My Questions for the Group I have learned so much just reading your posts, but I have a few specific things I’m trying to figure out:

1. The “Breathing Paradox” Does anyone else find that deep breathing exercises actually make the head pressure worse? I’ve been told to do breathing exercises for anxiety, but every time I try, the pressure in my head spikes. Has anyone else experienced this?

2. The Positional Confusion When I did my Dynamic CT, I put my head in the position that exacerbates my symptoms (looking up and to the left). Paradoxically, Dr. Aghayev noted that the gap between the bone and styloid actually increased in that position compared to neutral. I believe this is related to muscles affecting the nerves in that position. Did anyone else experience paradoxical symptoms versus imaging?

3. Sleep Sucks Any suggestions? My PCP has me on Trazodone. My biggest problem is getting to sleep. Once I am there, I usually stay there but falling asleep is so difficult now.

I am working on uploading some images.

Thanks again for letting me join the group.

Best,
Tusker

[Isaiah_40_31]

@Tusker,

Welcome! Thank you for sharing your story. I’m glad to know you’ve been proactively seeking appointments with the specialists who are most likely to be able to help you.

We’ve had a little trouble w/ Barrow doctors in the past in that the main one who does IJV decompressions has turned away several members who had extreme symptoms telling them they didn’t need surgery, & one he scheduled for surgery but when she got there for it, he cancelled the day before her surgery telling her she really didn’t need it after all. Having said that, we have a member who just reported today that he’s scheduled for IJV decompression surgery/styloidectomy at Barrow but doesn’t have a surgery date yet.

@Tusker

UCSF: Currently working on a referral for the Manometry.

Manometry is measured via a catheter venogram which is an invasive procedure & can have some post op side effects. When you get scheduled, make sure to speak to the doctor about what to expect during & after the procedure so you’re prepared for the experience.

@Tusker

1. The “Breathing Paradox” Does anyone else find that deep breathing exercises actually make the head pressure worse?

Deep breathing increases pressure in the lungs & abdomen on the inhale which impacts rate of blood flow. I suspect your breathing paradox has something to do w/ the increased internal pressure in your body during inhalations even though slow deep breathing stimulates the parasympathetic nervous system & ultimately helps with physical relaxation.

@Tusker

The Positional Confusion When I did my Dynamic CT, I put my head in the position that exacerbates my symptoms (looking up and to the left). Paradoxically, Dr. Aghayev noted that the gap between the bone and styloid actually increased in that position compared to neutral. I believe this is related to muscles affecting the nerves in that position.

Your assumption may be correct but added to that is the possibility that your IJV is being compressed by local soft tissues when your head is in the most provocative position since the styloid actually moves away from it. The SCM & posterior digastric muscles are the muscles most often noted as contributing to IJV compression. Additionally, connective tissue, lymph nodes, other blood vessels, nerves or scar tissue can also contribute.

@Tusker

3. Sleep Sucks Any suggestions?

Sleeping with your head & shoulders elevated (you’ll have to experiment to see what degree of elevation works best) at night can be very helpful. Some people have found icing their necks helps, too. Ice for 15 min. every couple of hours if possible. Gel ice packs work well because they conform to the shape of the neck. Use a thin towel or cloth between ice pack & skin to prevent ice burns. If ice makes symptoms worse then try heat.

A few members have mentioned taking a muscle relaxer has been helpful for various ES symptoms & if part of your compression has a muscular basis then that might be helpful. Getting an Rx for a blood thinner has also helped some of our members who have IJV compression. There are several that have been mentioned on our forum & the 3 that come to my mind are Brilinta, Plavix, & Xarelto. Diamox is another medication that has helped some people.

I look forward to seeing your images.

[Jules]

Hi & welcome @Tusker !
I can’t add an awful lots on to the thorough info @Isaiah_40_31 has already given you, but I would just suggest that although it might save travelling to have the venogram with manometry done locally, many places aren’t familiar with this & might not so all the measurements that Dr Nakaji particularly likes to see, so it’s worth double checking if this is all done correctly, as @Isaiah_40_31 said it is an invasive procedure so you want it done right & only once! Dr Nakaji works with a Dr Mehta, there have been a few discussions about this…
I was prescribed Amitriptyline for nerve pain, and that helped me sleep, along with being propped up for the head pressure. Do you have any nerve pain, or are the vascular symptoms your main issue?

[Tusker]

Hello @Isaiah_40_31,

Thanks again for the warm welcome.

We’ve had a little trouble w/ Barrow doctors in the past in that the main one who does IJV decompressions has turned away several members who had extreme symptoms telling them they didn’t need surgery, & one he scheduled for surgery but when she got there for it, he cancelled the day before her surgery telling her she really didn’t need it after all. Having said that, we have a member who just reported today that he’s scheduled for IJV decompression surgery/styloidectomy at Barrow but doesn’t have a surgery date yet.

I appreciate the heads up about Barrow. I did read a few comments about them. It doesn’t inspire a lot of confidence. Did the member who reported being scheduled for surgery share the name of the surgeon?

Manometry is measured via a catheter venogram which is an invasive procedure & can have some post op side effects. When you get scheduled, make sure to speak to the doctor about what to expect during & after the procedure so you’re prepared for the experience.

Dr. Aghayev did not think this scan was necessary. I explicitly asked him if the scans I shared were enough to recommend surgery, and he said absolutely. The scans he reviewed were enough, and no further imaging was necessary. Furthermore, Dr. Costantino did not request this scan either. Only Barrow officially requested it. To be honest, I would prefer to skip it altogether.

I know Dr. Nakaji is likely to recommend this scan too, based on what I have read here, but I think Dr. Nakaji is going to be out of network for me (still trying to confirm). Not a complete deal breaker, but the procedure will be significantly more expensive for me. At the moment, it seems like I am most likely to pursue surgery with Dr. Costantino in New York, who I have confirmed is in network for me. He did not ask for or even suggest I get this Venogram with Manometry. I live in California, so a flight across the country doesn’t seem very appealing, but it’s my best option at the moment. I’m sure the data from the scan would be valuable information to have, but I also want to avoid any unnecessary risk.

Also, I ordered a mattress elevator based on your recommendation and sent my PCP a request for Plavix. He has been very reluctant to prescribe anything for this because he has never encountered it before, but I am pushing a little harder now.

@Jules, thank you for your comment too. My symptoms are predominantly vascular but I have had a little bit of nerve pain too. (I think not enough to ask for Amitriptyline.)

I was able to strong-arm my dynamic CT Venogram. I had to spoon-feed the instructions to the imaging center via my neurologist, but they did everything I asked for. I asked AI to generate a very official-looking set of procedures for the exam and handed it to them before the procedure. (I asked Barrow to provide a similar document officially, but they declined.) The imaging center told me it was “very helpful”. I attached those generated instructions below for reference. My biggest mistake was not requesting to be turned in both directions, so I would definitely modify this if anyone tries something similar.

Dynamic CT Venogram Instructions.pdf (94.5 KB)

Anyway, do you think I should try something similar with the Venogram with Manometry? I am working through an open referral through UCSF for Dr. Amans. They are much closer to me than Arizona, but both are inconveniently far. I would prefer to stay local, but not if it means there is a high risk of having to do it twice. I am confident in my ability to advocate for what I need, but if this could be a “skill issue” for a local radiologist, I will wait it out for UCSF.

EDIT: I noticed an email in my inbox from the local imaging center right after I sent this comment. They declined to attempt the procedure or even recommend one nearby.

I am hitting my PCP with a lot right now, between referrals and medication requests. I don’t want to pile on at the moment, but I will ask him to send a duplicate referral to UCLA to try to see Dr. Gregory P. Lekovic, MD, PhD. Do you think that is worth the time to look into?

I am trying to check a lot of boxes. I want to find a high-quality surgeon, one who is in network, and one who is close enough to avoid flying (in that order of priority). Above all else, I want to avoid needing a second surgery to fix the first one.

[Tusker]

Also, I was able to take some measurements from a CBCT scan I had done. No idea if I did this right but this is what it looks like. I rotated to try and find the best angle to take a measurement. I could not get these views from the CT Venogram as I think the only images on the disk are from the incorrect left-extension position. Which shows a bigger gap, according to Dr. Aghayev.

[avarj]

Hey there.

I believe this is referring to me, as I just was told I am being scheduled for the decompression surgery with Dr. Lawton.

In my experience, both Barrow and Dr. Nakaji require the same set of diagnostic tests to see if surgery would be beneficial. Dr. Nakaji’s office was more difficult to work with and the tests are done outside his office, which has its own set of difficulties. For Barrow, they seem to only operate if you have the vascular or neuropathic versions of Eagle Syndrome. If it is just pain and discomfort, they don’t seem to keen on risking on operation…even if it could greatly help someone. I don’t know much else about their decision making, but I can tell you what my testing showed that led to a multi-disciplinary board review , the referral to Dr. Lawton and the ENT department to schedule the surgery.

My CT showed very obvious calcified elongation of the styloid process that extended down to C3, but not all the way to the hyoid bone. My jugulars are slightly displaced and don’t sit nicely against the front of my C1 transverse processes. They sit towards the edges and are being clamped by both my C1 and elongated styloid ligaments.

From there, both Dr. Nakaji and Barrow requested a Dynamic Cerebral Angio and Venogram. I went with Barrow because I was able to get scheduled much quicker and Dr. Mehta, who Dr. Nakaji referred me to, wanted to do a whole workup before testing, potentially prolonging this test by months. Dr. Andrew Ducruet, neurovascular surgeon at Barrow brain and spine, was the one who conducted my test. He was fantastic. He is well aware of vascular variants of ES and had me in the test for almost 2 hours - moving, twising and turning my head to capture as much as possible. He even repeated multiple maneuvers because the initial readings were inconsistent and this is how he found that my body compensates by sending a majority of the blood out the back of my head, which was used as additional pathology to diagnose me with the condition. All previous neurologists never mentioned this to me.

With all of this done, Barrow and Dr. Nakaji were looking for disturbances in vascular flow that was more than some number threshold that I am not aware of. My test revealed that dynamic movement of my head completely cutoff flow in my IJVs and pressure in my jugular bulb, sigmoid sinus and superior sagittal sinus doubled and tripled, depending on which movement was being conducted. From here, Dr. Ducruet informed me surgery may be beneficial for me and it would likely have to be a styloidectomy and shaving the C1 transverse processes to provide relief for the IJVs and allow normal flow. He was against stenting, as it was more invasive and believes once the IJVs were relieved, it was unnecessary.

Barrow ENT conducted a multi-disciplinary board review and ultimately agreed with his assessment, started the scheduling process and referred me to Dr. Lawton to explain the procedure and what to expect. Your symptoms are very similar to mine, the worse being the brain fog, neurologic deficits and headaches.

The deep breathing is hard for me. I believe the area around the compression has caused so much tension that my accessory breathing muscles in my neck and upper traps are always overstimulated, making it seem painful or impossible to breath really deep. Additionally, sleep has been a struggle. I was prescribed baclofen and clonidine and they have been a huge help.

Lastly, I the paradoxical nature of your positional pathology could be due to impaired cerebral perfusion from the veinous congestion. If your IJVs have been congested for some time, your brain may have adapted to the impaired level of oxygenated blood going to and deoxygenated blood going from your brain. I am not a doctor but if this process is chronic, “relieving” the compression may initially feel worse. This is why it takes so long for post-op recovery because its not as simple as opening up the jugulars. Your brain needs time to adapt to the “normal” flow of blood and delivery of oxygen.

This is a lot of info but I hope it helps you on your journey to recovery.

[Tusker]

Hi @avarj,

This is incredible. Thank you so much for typing all of that out.

Your timeline and experience with Dr. Ducruet is the confirmation I was looking for. Knowing that he was the one who found your compression when others missed it gives me some reassurance that traveling to Phoenix is worth it. Consider the following reply I just received from Dr. Amans team:

I think Dr. Ducruet is my only option. (I would prefer not to get every scan under the sun, unless absolutely necessary.)

I also received a major update that aligns with this Phoenix strategy:

Dr. Nakaji is “In-Network”: I just got off the phone with Dr. Nakaji’s office and found out I am effectively in-network with him now, so he is probably my top option.

My Current Plan (thanks to your post):

1. The Test: I am currently waiting for Dr. Ducruet’s office to call me back to schedule that Dynamic Venogram. UCSF/ Dr. Amans was my first choice, but I really don’t want to wait around in this condition for all those scans to be scheduled and then for UCSF to review them and then approve the Venogram and then hopefully get scheduled for surgery.

2. The Surgery: Once I have that data, I will pursue both Dr. Lawton and Dr. Nakaji, since both are now viable options for me. To be honest, time will probably be the biggest factor in choosing (if I have the option to choose). I am quite miserable at the moment and just want to be fixed.

Also, your theory about the accessory breathing muscles crushing the vein when we inhale deeply makes sense. It explains why relaxing breathing exercises actually spike my head pressure. I’m going to look into the Baclofen and Clonidine combo you mentioned, although I just asked my PCP for Plavix. I think I will wait before asking for more medication.

In that same vein (pun partially intended), did you (or anyone else reading) get these prescriptions from your PCP? If so, how did you go about that? My PCP wants to leave everything to the specialists regarding medication for this condition. Should I wait for an appointment with one of these neurosurgeons to ask for medication?

Thank you again for sharing,

Tusker

[avarj]

I got the prescription’s through my neurologist, not PCP.

I would wait until you get in with one of your options listed above and ask what meds they can give to help with the sleep. They should have you covered.

[Isaiah_40_31]

@Tusker & @avarj - Great conversation. I am so glad that you’re both “in the same boat” & have been able to share your experiences with each other. I appreciate the information exchange as I learned some things as well.

Tusker, Dr. Amans office is notoriously slow at making appointments so your plan to skip what they require & look at going to Phoenix makes much more sense from a time standpoint. Please let us know how things go for you once you get scheduling appointments. Getting more than one opinion is a good idea, too. If you have an appt scheduled w/ Dr. Costantino, I’d keep it just for comparison sake.

One reminder regarding styloids - it’s often not the length of the styloids that is causing trouble but other physical features such as angle of growth, how curved, pointed, twisted, or thick they are. Some even grow with little spikes protruding from them, thus normal length styloids can still be problematic.

[Jules]

Wow @avarj , that’s really helpful info, thank you- I love the way this site works so well to share experience & help each other…
@Tusker the AI request for your dynamic CT is a great idea, I hope this helps others too! And sounds like you have a plan for moving forward now…

[Tusker]

@avarj, I messaged my neurologist to see if he can prescribe me anything to help me get through to my appointments. He is evaluating medication but in the meantime, he was able to move up my local neurosurgeon visit from March 3rd to February 24th. I know he won’t be a consideration for corrective surgery but I plan to use that visit to help with medication requests and possibly for sending more referrals. (Please suggest anything else I should ask for during that visit.)

@Isaiah_40_31 & @Jules , I agree, this has been a really helpful experience already. I did ask Dr. Amans’ office to send those imaging requests, even though I don’t intend to follow through with them at the moment. It doesn’t hurt to have them available.

I will report back with any updates, and I will follow your thread too, @avarj.

[Isaiah_40_31]

@Tusker

I did ask Dr. Amans’ office to send those imaging requests, even though I don’t intend to follow through with them at the moment. It doesn’t hurt to have them available.

Good job! It’s always a good idea to be ready for additional steps if necessary, in order to get the care you need!

[Jess1]

Hi! I have similar symptoms to you; difficulty breathing is one of my worst symptoms. I’m also seeing Dr. Mehta / Dr. Nakaji soon. I’d love to hear about your experiences and keep each other posted since we seem to be in a similar boat!

@Tusker I started having severe insomnia issues about 8 months ago. If you’re able to, I highly recommend seeing a CBT-i therapist; I didn’t think it would help but it does, at least with coping mechanisms. I also got a sleep medicine doctor; I build tolerances to medication insanely fast so having a sleep medicine doctor has helped me be able to try out different ones and discuss being on a rotating schedule of meds (when needed). I hope you get the help and support you need; just thought I’d chime in with this because insomnia is awful when it’s out of control.

[Tusker]

Hi @Jess1,

Thank you for sharing! Thanks to @avarj, I was able to get my neurologist to prescribe me something. He put me on 100mg of Gabapentin, 3x a day. The idea was to try to get me some small (safe) relief until I can actually see a neurosurgeon who can prescribe something appropriate.

The effects from the Gabapentin were very noticeable in the first few days. I slept great the first night. Fine the second night. And back to my usual terrible sleep the third night. I needed a trazodone to put me down because it wasn’t happening with gaba alone.

I know 100mg is a tiny dose, but the effects outside of sleep have been good too. I was in a severe downward spiral the last two weeks. Every day was worse than the last. Especially the lightheadedness and pressure. Since starting the gaba, those two have seemed to stabilize and maybe even improve slightly.

I was seeing a CBT therapist for over a year before I knew I had VES. Maybe I could try again. My problem is the breathing exercises. I have no difficulty breathing, but whenever I try those deep breathing exercises associated with meditation, my intracranial pressure increases.

I will look into a sleep doctor, too!

I look forward to hearing about your experience with Dr. Nakaji. He has had my scans for a few weeks. I am just waiting for his review. I am also waiting for an appointment with Dr. Ducruet for the CT Venogram with Manometry. I really hope to have news about both this week.

Thanks again,

Tusker

[Jess1]

I’m glad you’ve been able to get some help! Nothing is worse than symptoms piling up and no way to manage them.

I meant CBT-i specifically, it’s a separate certification for insomnia. I’m in “normal” therapy but also see a CBT-i therapist and we solely focus on sleep / things connected to sleep. That said, if gabapentin and trazedone are working for you, maybe it’s not worth seeking out at this time.

And nice! The process for Dr. Nakaji’s office has been a bit confusing and frustrating but I finally have my ducks in a row there so I’ll try to remember to come back after my next set of imagine + if I have a consult with him!

[Tusker]

@Jess1 Ah, that makes total sense regarding the CBT-i certification. I didn’t realize there was a specific branch dedicated entirely to sleep mechanics. If the current regimen stops working, I will absolutely look into a CBT-i specialist.

I received and started using the “mattress elevator” 2 nights ago. It’s hard to be certain, but it feels like I am waking up with slightly less pressure than usual. Good enough to keep using it for now at least.

I finally got the call back from Dr. Nakaji’s office yesterday. He reviewed my scans and said the imaging shows “possible mild to moderate compression on the right at the styloid C1 level”. My styloid measures 29mm long.

As expected, Dr. Nakaji recommends a Catheter Venogram with Dr. Mehta (but specifically named Dr. Ducruet and Dr. Amans as acceptable/recommended too).

He noted that my scans were pretty low quality, and if the Cather Venogram is inconclusive, he may ask to have a regular CT Venogram done again.

Dr. Ducruet’s office has already approved the Catheter Venogram. I am just waiting for their scheduler to call me.

In the meantime, I asked my PCP to send a referral to Dr. Mehta’s office to request the same procedure. I will attempt to schedule both and then cancel whichever is later.

Dr. Nakaji’s office also mentioned that he will be out of the office from March 9th through March 20th. He suggested I try to book the Catheter Venogram after, and they will do their best to book my initial consult with Dr. Nakaji for either the same day or the following day to avoid making a second trip to Arizona.

UCSF (Dr. Amans’ office) is being fairly difficult. (I know @Isaiah_40_31 already mentioned his office is slow but I can’t help myself hassling every doctor I can to try and get things done quicker.) Not only do they refuse to do the Catheter Venogram until I get three additional scans done locally, but they refuse to even tell me how far out they are scheduling these procedures. I begged for an extremely rough timeline (e.g. ~3 weeks once Dr. Amans confirms the procedure is necessary). They won’t do it.

So, unless Dr. Ducruet and Dr. Mehta are both booking several months out, I am giving up on UCSF. Arizona is much further for me, but UCSF is just making it really difficult.

I meet with a local neurosurgeon on Tuesday, February 24th. I plan to ask him for a “pharmacological bridge” to carry me through at least the Catheter Venogram procedure, if not to the eventual (hopeful) surgery.

[Isaiah_40_31]

@Tusker - I’m sorry you’ve gotten the run around by Dr. Aman’s ofc. I do not understand why things are as they are there. So frustrating for patients. I’m glad you have Dr. DuCruet & Dr. Mehta as back-ups & hope you can get in with one or the other at a time when you can have your follow-up w/ Dr. Nakaji on the same trip.

If you go looking for a pharmacological bridge, ask for a blood thinner as that’s what has seemed to help the most for our members w/ IJV compression. I don’t recall if I mentioned it before but Brilinta, Plavix, & Xarelto are among those most often mentioned here. Diamox is another potential help w/ head pressure but it can have unpleasant side effects. Keep in mind it can take 3-4 weeks for a blood thinner to reduce brain fog/head pressure symptoms.

[Tusker]

Hi @Isaiah_40_31,

It would indeed be great to have everything (except the surgery) done in one trip. I am hoping it works out that way.

I am already trying to work out the logistics of that trip. It is either a ~2-day drive or a ~2-hour flight for me. I have read bad things (on this forum) about people taking flights with IJV. I have a little concern about flying only for that reason. Not that 2 days in a car is particularly appealing either.

I also don’t know if I need to bring someone with me for that Venogram. It sounds about as invasive as an exam can be. I can have someone there but, obviously, it makes all the logistics twice as expensive.

For the pharmacological bridge, I believe you did recommend Plavix. I actually requested that from my PCP, but he declined. I did not ask my neurologist for anything specific. I was a little worried about appearing “drug-seeking” so I just asked him if he could prescribe “something to help”. (That is how I ended up with a Gabapentin prescription.)

I plan to use AI to build a thorough list of recommendations for the neurosurgeon visit next week based on @Jules post about Pain Relief, Medications and Alternative Therapies.

Considering a blood thinner takes 3-4 weeks to reduce symptoms, is it going to be worthwhile to start it before the Venogram? I would think they would ask me to be off blood thinners before doing a procedure that involves going into an artery, but I really wouldn’t know.

[Jules]

Good that Dr Nakaji wants to look more at your case, I hope that you don’t have to wait too long for the venogram… There have been some posts about what’s involved, so you can decide whether you can manage alone or not… Good point about the blood thinners and the venogram, you’d need to check out how early they’d want you off them before the procedure & see whether it’s worth trying them or not…

[Chrickychricky]

I don’t think Dr. Aman’s office is making it difficult as much as it is just difficult. He does this testing through UCSF’s pulsatile tinnitus clinic. That clinic, being only 1 aspect of his job, only meets 1 day a week. Since they are one of the only pulsatile tinnitus clinics in the world you can imagine that they are inundated with requests for appointments. So the testing they are requesting you have before getting an appointment is to confirm that you are a good candidate for one of those coveted appointment slots. If you were able to get that first appointment and it looks like having the IR venogram is worth it, the process of getting that set up goes faster. USCF is a teaching hospital so, unlike the first pulsatile tinnitus appointment where it is you and Dr. Amans (and Alison) one on one, the IR venogram is done with him running the point position while senior fellows (highly qualified) perform the testing. That means several interventional radiology procedures are happening simultaneously and is much more efficient from a time perspective. If all of that makes sense and doesn’t sound good to you, Dr. Mehta makes more sense. I think Dr. Amans and Alison are tremendous and I feel very fortunate to have had their assistance but it is definitely a long process. I wish you the best.