Hey All!
Quick update and quick question… I just had my tele consult with Dr. Hepworth’s nurse practitioner and she was great. Unfortunately, they want to see me in person before I can do anything else, such as trialing medications and getting the ultrasounds done. I asked their office multiple times if I should come for an in person appointment or telehealth and they said video was no problem. I could have easily driven there for the appointment but now I have to wait another 7 weeks for my in person appointment to get the ultrasounds and even get on the surgery schedule. That is slightly annoying. But other than scheduling, their office has been great to work with so far.
I am meeting with Dr. Liu in two weeks and in thinking about comparing his approach with Dr. Hepworth, I remember reading on this forum that Dr. Hepworth will often relocate the jugular vein out of the way of the compression instead of having to decompress more structures. I am not sure if I am accurate about this, but just something I remember hearing about.
If true, my question is, many of us have more than just the jugular vein being compressed. I am certain my nerve bundle is also being compressed, making this not a pure vascular issue. Does anyone know how Dr. Hepworth views the nerve compression in this area. I assume if he’s relocating the jugular he isn’t also relocating the nerves. So this leaves me wondering if just moving the vein but not addressing the compression of the nerves will actually resolve symptoms. Or, does a more aggressive 360 degree decompression such as what Dr. Liu performs, while possibly riskier, give a higher chance of comprehensive symptom relief by decompressing that nerve bundle and whatever else is “unseen” in that area?
If anyone can help fill in these gaps, I would be interested to hear more. Obviously, I would like to talk with Dr. Liu and Dr. Hepworth about these directly, but like I said I have another 7 week wait before I get to speak with Dr. Hepworth directly and honestly by then I might be well on my way to surgery with Dr. Liu since his office seems to be moving so much quicker.
Take care!
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@biggfish02 - As long as I’ve been on this forum (since 2014), Dr. Hepworth’s system has been initial consult w/ one of his NPs followed by an in-person consult with him. When I saw him the practice was an in-person consult w/ the NP followed by a US the next day followed by an in-person w/ Dr. H on the third day. Because he’s gotten so busy, the timeline has changed though the set-up more or less remains the same. If you didn’t ask to be put on Dr. H’s cancellation list, please call his office & request that as sometimes appointments can be expedited that way.
You are correct that Dr. Liu’s office is moving at a faster pace right now. Surgery w/ Dr. Hepworth probably won’t be till next year, even if you see him in 7 weeks, though it’s possible he’s giving priority to patients who’ve already had a consult w/one of his NPs.
I had IJV decompression done by Dr. H. He did a revision styloidectomy for me as mine wasn’t cut short enough the first time. That stopped my nerve pain. Because the C1 impingement on my IJV was more minimal, he was able to move my IJV away from C1 which allowed it to open sufficiently. He told me there’s a little groove in which the IJV naturally sits so he puts it back there. I assume it gets pushed out of that little groove by pressure from the styloid/C1. To review - it’s the styloidectomy that allows for recovery from nerve pain & the IJV decompression that provides relief from vascular symptoms.
In cases more severe than mine, he now does a styloidectomy with C1 shaving though it seems he’s a bit less aggressive with that than some other surgeons. For many patients his strategy & surgical technique provide good results, but for others, a more aggressive approach would have been better so revision surgery is sometimes needed. I must say here that he is not the only surgeon doing IJV decompressions/styloidectomies who’s had patients who’ve ended up seeing other doctors for revisions later. Though it’s somewhat uncommon, it does happen. Doctors doing these specialized surgeries have to make decisions during surgery as to exactly how to approach the situation they see once the neck is open. Erring on the side of caution is often better for a patient than a blatantly aggressive approach, but as noted, that can sometimes lead to the need for a revision.
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