Sorry to be reply so late!
Absolutely get the surgery when you still have your amazing health insurance coverage! I hope your appointment with Dr. Costantino went well, and that your surgery date is scheduled.
Good luck with the surgery and big congratulations on opening your own business!
Wishing you all the best on both fronts.
@KimberlyNYC @GCD @BriCSP Can I ask you guys how many weeks or months you had to wait for your first appointment with Dr Costantino?
Hi Buzz!
I was lucky to get an appointment pretty quickly - within a few weeks of calling, maybe even slightly less than two weeks. I saw him in NYC (vs his practice in Great Neck). Maybe I got lucky? I had initially seen a head and neck surgeon who doesn’t do ES surgery, but he had trained with Dr. Costantino and told me he was the surgeon to see,
If the wait feels too long, you can always ask his office to put you on his waiting/cancellation list with the hopes that an earlier appointment will open up. They’re super responsive. I hope it works for you with perfect timing!
P.S.: I just read your earlier post - wishing you all the best as you continue to get answers. It’s a long way from Sydney to NY (I’ve made that trip!) - hopefully they can fit you in sooner rather than later.
@KimberlyNYC Thanks so much! I met with Dr. Costantino last week and he thought I definitely seemed like a candidate for surgery based on my CT scan, but he wanted to do a CT-V scan to get a more comprehensive picture of my jugular vein compression before proceeding. That’s scheduled for Friday and my follow-up is next week. I appreciate that he doesn’t just rush you into the OR but takes his time to try to guarantee success as much as possible. He was also talking about various surgery techniques he’s developed over the past few years that have improved the odds of decompression. He is concerned about some disc issues I have in my cervical spine because of the position I need to be in during surgery, but he’s going to consult with a spine surgeon in his practice when I get the CT-V results.
@Buzz I waited about three weeks to see Dr. C the first time, but they were very apologetic and acted like that was atypical. I also saw him in NYC. I’m still anxious to see how far out he books surgery, but I mentioned I’m opening my own business and losing my health insurance in August and they said that’s way more time than they need. So that was encouraging! I’ve also found his office very easy to work with.
@buzz My appointment was done in a round about way. Since I consulted and did my imaging tests first with Dr. Patsalides and Dr. Lo, Dr. Constantino already knew that I was a surgery candidate. I was scheduled 1 month out from surgery to do a telemed with Dr. Constantino.
I saw your CT with contrast and would assume you could send the scans to Dr. Constantino and do a telemed like me to have him review and discuss with you his surgical recommendations since you are located in Australia. Then if he does consider you a surgical candidate, could do the in person consultation and surgery in the same trip.
If you go the route I did and get the C1 shave, which I will discuss in your other post, Dr. Lo and Dr. Constantino will only do surgeries together on certain Tuesdays of the month. I think Dr. Constantino and Dr. Lo could have scheduled me for surgery within about a month of my consultation, but because of the limited dates they work together it took about 2.5 months to get scheduled.
Thank you @KimberlyNYC !
That’s great news, thank you. I think my biggest delay will be getting a 6 month B2 visa to the USA (6 months wait just for the application interview). I could try for an instant ESTA visa if I only need 3 months in the USA. But I feel like that might not be enough time to get both TSPs removed if that’s necessary.
@BriCSP Thank you. That sounds amazing. Do you remember any specifics about the techniques that he mentioned?
@GCD Thank you. Yes, that would be the idea. But the scans I posted are from 2014, so I’m first booking to meet an ENT in Australia to get new scans, and hopefully he will order the other important scans, like a cervical venogram, dynamic cervical CT venogram, etc. I’m trying to compile a list of exactly what would be required by a surgeon like Dr Costantino.
Since I would be travelling to the USA for a limited time, I want to make sure that I’ve gotten as much as possible done here first.
Thank you! That’s very useful information for scheduling. I assume that you mean 2.5 months from your telehealth consultation? And then do you have an in-person appointment scheduled for just before the surgery date?
I can easily get an ESTA visa for 3 months to the USA. I’m hoping that that would be enough time to at least get surgery completed on one side.
ESTA gives you I think 6 months per calendar year, or so. You can simply leave the USA for a few days (for Canada/Mexico).
@vdm Unfortunately, from a brief search online, it looks like that might not be possible:
“Where must you travel to in order to before returning on an ESTA to get a new 90 days? You must leave the whole North American region completely to reset this. You can’t just pop to Canada or Mexico to try and reset the 90-day counter. In fact, a short trip to Canada, Mexico or nearby islands are included in your 90 days if you attempt to return to the US”
You must be right, the Visa Waiver Program says the same. So perhaps then the option is to fly somewhere to Central America or Europe…
Hi Buzz. I wanted to share some information about surgical timing - particularly the interval between surgeries on left side and right side - as it may impact your visa decision.
Everyone has unique recovery trajectories and you might be in the super healer category! The general guideline that Dr. Costantino communicated to me is optimally waiting 6+ months between surgeries on each side. (I don’t know if this is his general recommendation, but sharing for some context of timing). He did mention a case of someone who felt so much better after their first surgery that they wanted to do the second side after 3 months (and they did).
Can’t remember if you’ve mailed/are planning to mail CDs with your images but you could also ask his office if they use Nuance Powershare. If they do, you can actually upload all the images from your imaging CDs and electronically transfer them to any doctor who uses that medical image sharing program. * Some imaging centers tag the images in a way the Powershare rejects so it’s not a guarantee, but worth trying if they use it.
He mentioned shaving the transverse process (though I think he actually said something like “puncturing”) and cutting into some fascia to expand it, both of which have increased the odds of decompression. Sorry this is a bit vague, he didn’t really want to get into the surgery too much, I think to avoid getting my hopes up if my CT-V scan shows I’m not a candidate. Presuming I am, I should know more after my consultation next Wednesday.
Yes, 2.5 months from my telehealth.
Yes, then an in person appointment just a day before your surgery. I did it this way before having my catheter venogram testing done with Dr. Patsalides, which was considered a minor surgery. I assume Dr. Constantino would allow this for someone traveling internationally as long as all the testing requirements were met beforehand.
You could probably do the consult, surgery and recovery in about 3 weeks, so the visa thing shouldn’t be an issue. I am having my surgery May 16 and flying back home May 23, but I’m flying domestically New York to Florida on a 3 hour flight. You would obviously want some extra buffer time traveling internationally, so about 3 weeks. I will post my results so you can gauge the recovery time frame.
Edit - Sorry, I missed your post saying you would like to do both styloids in one trip.
When I had my ES surgeries many surgeons were requiring 6 mos between surgeries (including mine). It seems now, a lot of those doctors have cut that wait back to 3 mos. The advantage of the 6 mos wait is more complete healing before the second surgery so the body isn’t still trying to recover from the first surgery while also dealing w/ a second one. The disadvantage is that 6 mos is a LONG wait when you’re feeling awful & just want to put this all behind you. I don’t think any of our members who’ve had only 3 mos. between surgeries have suffered unduly during recovery, so there lies an argument in favor of a shorter time between surgeries since you’ll be limited by a visa.
@vdm @GCD After reviewing accommodation costs for three months near NY, it’s looking like it might simply be cheaper to return to Australia after the surgery, and pay for another return flight for the second one later. Expensive, but straightforward. Only about 100 hours of flying! 
Yeah, living cost in the US is ridiculous especially in & around big cities. Start planning your flight entertainment now. 100 hrs is quite a bit of “air time”. 
@KimberlyNYC Thank you for all of that information! It’s extremely useful.
I will definitely try to send them the DICOM files using that method.
I haven’t sent anything to Dr Costantino or spoken to his staff yet. I first need to meet with an ENT here in Australia and get new scans ordered. I have a two month wait until that appointment. The scans I uploaded here were a decade old, and were not ordered to detect ES.
Don’t know how things work down under… But I was able to get my primary care physician to order my CT scan. I have an unusual situation, and that we have a 25 year relationship… So he has been wonderful and getting what I need, while this is not really his wheelhouse. Just a thought if you happen to have a situation similar.
I’m sorry that you have to wait 2 months for your appointment and new scans. So much of ES seems to be waiting: for a diagnosis, for effective treatment … perhaps the ENT’s office would put you on a cancellation waiting list and a spot will open up sooner.