I’ve been browsing all the stories and my heart goes out to all those in so much pain. My pain has subsided for the most part, I don’t know why. The only pain I have now is my ears. I went through the throat issues, hearing my heart beat in my ears, and ear fullness. Thankfully, most of that has gone away. I sent my CT to both Dr. Cognetti and Dr. Hackman. Both called back and said I need surgery. I was able to schedule with Hackman rather quickly, set for early November.
In the meantime, I already had an appointment scheduled with Dr. Morrison in South Florida. He was not so quick to say that I need surgery and he sent me for multiple tests, including Xray, MRI’s and CT’s with/without contrast so that he could see what else was going on. I go back to him on October 21st to see what he has to say about all the testing. I don’t think I’ll use him for the surgery, only based off of the fact that so many believe that Dr. Hackman is the more experienced doctor in this field.
My question is: How can Hackman and Cognetti say so quickly that I need surgery after only seeing my CT? For both doctors, you need to fly there, meet the doctor and surgery the next day. They have no other background information on what else may be going on with nerves and or vein compression. I like that Dr. Morrison is doing more investigation. Are the other 2 doctors just saying lets operate because they are, after all, surgeons. Am I wrong for being a bit nervous about meeting a doctor on Tuesday and him operating on Wednesday? I am putting a lot of trust in a doctor that I have never met. I’m wondering why he didn’t request the testing that Dr. Morrison asked for.
Of course I’ll send him all the images that I have from the other tests but I just wonder why he doesn’t think that he needs them. What if I had other issues going and he didn’t know about them?
Can someone that has seen Dr. Hackman or Cognetti enlighten me please? It’s is coming up soon and I need to know that I am making the right decision.
Thank you for this site and for all of those that give great advice.
@Erin1 - That Drs. Cognetti & Hackman schedule surgery the day after an initial consult is news to me. I don’t think we’ve had any members who’ve been scheduled that quickly for surgery after a consult w/ either one as they both book out at least several weeks for their surgeries post consult even for patients coming from out of state or out of the country. I recall that one or two of our members were able to get their surgeries w/ Dr. Hackman scheduled w/in a few days of their consult so they didn’t have to travel home then back to NC later, but beyond that, I’m very surprised about what you’ve said.
Dr. Cognetti is booked into April next year for consults & only does consults & surgeries one day a month for ES as his focus is cancer patients. I don’t know how it would be possible for him to get you in for surgery that soon after a consult. Is it possible you misunderstood?
Dr. Cognetti was on our Doctors List when I joined this forum in 2014, & Dr. Hackman was added soon after I joined. They’ve been diagnosing & doing ES surgeries for more than 10 years so have a lot of experience with it & both have a high success rate with their surgical results.
If you had a CT with contrast, vascular compression should be visible so no further testing would be necessary to see if that’s a problem for you. Some of our vES surgeons prefer to know what the blood flow velocities are through compressed veins to make sure they feel surgery will help so that may be what Dr. Morrison is pursuing?
As far as nerves go, we, & knowledgeable ES doctors, can fairly easily surmise which nerves are being compressed/irritated by the symptoms you have. The only way to see nerve compression is for you to get a FIESTA or CISS MRI which can be hard to come by & is often not covered by insurance so very few of our members have bothered to try to get that done.
I’m glad Dr. Morrison is being cautious & has ordered additional testing as that will hopefully ease your mind that you’re making the right decision to have surgery. Based on two of the most experienced ES surgeons on our list recommending you have surgery, I expect it will help resolve your symptoms over time, & you won’t regret having had it done.
Thank you for your reply. No, I am not mistaken. The consult is on Nov. 4th and the surgery is Nov. 5th. If you find it strange, you are not alone. I would have been more comfortable having a discussion, time to process and then surgery. But that is not the case. I have called them twice to go over this and both times they have confirmed that surgery is on Nov. 5th. I am still waiting for them to get in touch with Aetna so I can get an approval and a quote. It has been over a month and they have yet to do that. I will call them again a third time to make sure that is how it is being scheduled.
It all seems a bit rushed but yes, that is how they set it up.
Thanks.
You’re at liberty to postpone the surgery if you want time to digest what you learn during your consult & especially if you don’t have certain prior insurance approval. I’m sure they would reschedule it in Dec. or Jan. if that’s what you’d prefer. I’m wondering if they’ve gotten push back from people coming from out of state regarding to have to travel there twice i.e. once for the consult & then later for the surgery so they’re trying to schedule those two things back to back now?
Perhaps the reason it is schedule for the next day after the consult is that she originally told me that the consult was for Oct. 31st. I told her I could not make it on that day, I have a wedding to attend. She then said let me check something, and then said, you can have the consult on the 4th and surgery on the 5th. Maybe she is accommodating and squeezing it all in so I don’t have to fly back and forth. Either way, it is soon and I am hoping for the best.
Yes, I wrote a letter alone with the CT. It is clear from the CT that I have huge styloids hanging down. Well, I think they are huge. I have no measurements. I just did the CT with contrast today so I will await the report and see what it says. I will forward that to the doctor.
I know. I guess he figures I contacted him because I want surgery and he is a surgeon. IDK. I will feel better after talking to Dr. Morrison and hear his take on it. I guess the only way to feel better is to have surgery. My head is in a constant state of “hey, something doesn’t feel right” so I do want it fixed, yes.
The prospects of surgery & recovery are scary so it is important for you to be comfortable with your surgeon and his/her approach to your surgery & not feel rushed or pushed into having surgery. I can’t remember if you’ve received the list of questions to ask a prospective surgeon (ask Dr. Morrison these questions to get an idea of his experience, too) so here it is:
**Questions To Ask Your Doctor:
How many ES surgeries have they done and what was the success rate?
Whether they’re going to operate externally, or intraoral- through the mouth. Whilst some members have had successful surgeries with intraoral, external is better for seeing all the structures, to be able to remove more of the styloids, & also there’s less chance of infection.
You need to ask how much of the styloid he’ll remove- as much as possible is best- & anything left needs to be smoothed off. The piece needs to be removed too- some doctors have snapped it off & left it in! If the styloid is only shortened a bit it can still cause symptoms.
If your stylohyoid ligaments are calcified, then any calcified section needs to be removed too.
There’s usually swelling after surgery; you could ask if a drain’s put in to reduce swelling, or if steroids are prescribed. It’s not essential, but can help with recovery a bit.
Will it be a day case surgery or will you need to stay in?
Obviously ask the risks- we know from experience on here that temporary damage to the facial nerve is quite common, and also the hypoglossal nerve and the accessory nerve. These usually recovery very quickly but in some cases members have needed physiotherapy. There is also the risk of catching a blood vessel or having a stroke, but these are very rare.
Ask if the surgeon monitors the nerves- this should be done to see if there’s stress on the nerves to avoid damage as mentioned above.
What painkillers will be prescribed afterwards.
Ask about recovery- most doctors either down play it or are genuinely unaware of how long the recovery can take!
We have heard that occasionally doctors use surgical clips which are left in, it’s been suggested that these could interfere with chiropractic adjustments if needed post-surgery, so something to consider, and also we have now seen members who’ve been left in pain from the clips and needed further surgery to remove them, so do ask if they might be used.
Here’s the link to the full post about surgery which @Jules wrote:
I am scheduled with Dr. Hackman for a January 6 consult and January 7 surgery. I’ve been dealing with this since 2010 and currently know I need a bilateral revision purely based on my imaging, symptoms, and knowledge from working in the medical field. I’m not concerned about how the scheduling is set up but I can understand your hesitance.
I had a telehealth consult with Dr. Osborne in LA who said I needed surgery. Also my surgeon in Portland, Dr. Patel acknowledged my need for a revision but didn’t want to do it because of the risks and scar tissue. I don’t think he’s done any ES surgery from an external approach which is what I need. I have worked with surgeons in a role where we were evaluating the work of other surgeons (expert witness work) and one of the things we always said was “a cutter is going to cut.” That said, some surgeons are more ethical than others and will decline inappropriate cases. I currently work in a role where I authorize surgeries based on causation and medical necessity so I’ve read thousands of surgery consult chart notes. Patterns emerge and the financially motivated show themselves. In my experience, it’s a very few that are prone to operate on people who don’t need it. They will typically show a lot activity at the state medical board with complaints and malpractice claims.
I can only speak for my own case, but I trust Dr. Hackman’s evaluation of my records. I haven’t contacted Dr. Cognetti. If you decide to postpone with Dr. Hackman, I am on his cancellation list and will fill it at a moments notice. I’ve been waiting for Dr. Hackman since the first of June and off work due to loss of my voice since July so I’m beyond desperate.
@Kiki67 - We’ve had members who’ve been given short notice about cancellations/postponements for appts & surgeries w/ Dr. Hackman so they do come up. I hope there is one w/ your name on it considerably before January.
Thank you for the advice. After getting my CT with contrast the other day, it is clear that I do need surgery. I guess my head just needed concrete proof beyond the initial CT. I had loss of voice for bit too. The only thing I did was take Advil for about a week and most of my symptoms subsided. Still have ear pain though. I was originally scheduled for February, but a week after making that appointment, they called with a cancellation so of course I took it. It just made it all very real at that point. Having 5 months to ponder it and get mentally ready as opposed to 7 weeks was a bi of an “oh, this is really happening” moment and it kind of hit me. My head was swimming with questions: Am I prepared? Did I do enough research? How will I get time off work? What is recovery like? Will insurance cover it? The list goes on. But I am good now I have all my ducks in a row and it’s all systems go. Tina was the contact at Dr. Hackman that was so friendly and helpful. She is on vacation until Oct. 20. But I would call her and plead your case, and I bet she will find something much sooner for you. People cancel all the time so I know you will get in sooner than January. I am wishing you the best possible outcome and hope you get some relief between now and then.
Erin
Hackman never returned my phone calls, so assuming his office is busy and you have to call and leave multiple messages to see him. I don’t think it is odd for surgeons to schedule the surgery the day after appointment given they can get insurance approval. Many surgeons know exactly what they can and cannot do and usually are comfortable with the particular surgery they perform. It is more up to the patient to decide if a particular surgeon’s technique is best for them. This sounds backwards and it is, but welcome to modern medicine driven by search engines and AI. Surgeons make much more money doing surgery, but I don’t think many of them would put a patient in any harm just to do more surgeries in a year.
@Kiki67 thanks for the info about your job; that’s really interesting! I hope that you can get a cancellation for your surgery @Erin1 , I hope this has reassured you more, & let us know how you get on with Dr Morrison!
