Hi all. I am a little leery of posting. I find the posts quite helpful to read but I am a bit nervous to post. Partially because I am a bit shy and partially because this makes my upcoming surgery a reality. I am simultaneously excited and terrified. I have VES and am having a left styloidectomy with Dr. Cognetti on 3/3/23. I guess I am looking for words of encouragement. Also wondering what to expect post surgery. Did most have outpatient? I have been told it could be either. Anyone have direct experience with Dr. Cognetti? I have met with him in person once and a few times virtually. He came across and patient and competent. I am wondering what anyoneâs experience with him was? Any advice would be greatly appreciated. Thanks.
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Hi @karen1!
Iâm so glad you wrote a post! Iâm so glad you have your surgery scheduled. Dr. Cognetti has been immensely helpful for our members whoâve seen him. He didnât do my ES surgeries so I canât give a personal opinion.
The most important thing for you to know about surgery/recovery is that it IS NOT an instant cure for ES symptoms. It can take a number of months post op for symptoms to gradually go away. You may find youâre more tired than normal for 1-2 months post op as your body tries to convince you to rest so it can heal. Symptoms tend to come & go & come & go during recovery as nerve healing isnât straightforward. Bad days may follow good days but in the end, the good days win. Some symptoms will disappear so slowly you wonât notice theyâre gone until theyâve been gone for awhile.
Many surgeons do ES surgery in an outpatient surgery center w/ the caveat that if the surgery is more challenging than expected, an overnight hospital stay may be mandated. That is the exception rather than the norm though. Most people are able to go home/to their hotel/lodging the same day as surgery.
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Thank you. I had a stroke about 18 months ago. Besides VES, Dr Cognetti said my styloid is âpokingâ into my carotid. I am hoping to get eventual relief from the constant tinnitus, head pain, balance problems, insomnia, autonomic dysfunctionâŚ
Even if only a few are resolved I will consider it successful. I truly find it comforting knowing I am not the only person suffering from this.
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Having a stroke must have been VERY SCARY, @karen1. Iâm so sorry you experienced that!!
The symptoms you listed are all associated w/ ES & the worst ones w/ vascular ES. I hope for you that all those symptoms go away post op. If you have bilateral ES it may require having both styloids removed to get a more complete recovery. That was true in my case anyway.
I will put your surgery date on my calendar & pray for you especially that day. 
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So sorry that youâve had a stroke already- makes it even more important to get the surgery done. Good that you have an experienced surgeon and Iâm glad you found Dr Cognetti patient.
Iâm UK so havenât had surgery with him, but I had VES & the symptoms went quickly after surgery, I felt lots better. I was really worried beforehand, but the recovery wasnât as bad as I expected. There are lots of recovery stories on here if you have time to read them- just search for âwhat to expect after surgeryâ.
One of our members did a surgery shopping list, hereâs a link:
Surgery shopping list - General - Living with Eagle
Itâs important to sleep semi upright, so the wedge pillow is handy, and to keep icing to help with swelling. It can often be hard to chew after surgery, so ingredients for smoothies & soft foods are a good idea to get ready, plus something to help with constipation as the meds can cause that!
As @Isaiah_40_31 says, recovery can be up & down, days 3-5 can be the worst as swelling peaks then, & the effects of the anesthetic will have worn off then, so be prepared for that!
Hopefully others whoâve had surgery with Dr Cognetti will chip in as well.
Surgery date noted 
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Thank you so much for your input. I appreciate the link to the supply list. I am definitely nervous but also hopeful. I canât wait to get back to my normal self.
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Thank you guys for your advice and support. I was initially set for surgery for the beginning of March. I apologize for not responding earlier. A week before my surgery, I was informed my insurance denied it. I was devastated. Dr. Cognettiâs office did a peer to peer review within a few days of the denial. That also was denied. His office then told me they would try an appeal. Dr. Cognetti along with input from my cardiologist and neurologist from Hopkins sent in the appeal on Friday March 10th. They told me it would take about a month before I heard anything. The following Monday morning on 3/13 they called to tell me I had been approved! I was so relieved. I figured it just wasnât in the cards for me. My surgery is scheduled for this coming Monday 3/27. I am once again pretty scared but also excited to have this behind me and hopefully on the road to recovery.
Again, thank you all for your kind words of support and encouragement! Wish me luck!!
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So pleased for you that the appeal worked, & how good of Dr Cognetti to go to bat for you like that! I hope that this time all goes smoothly & your surgery is successful
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Thank you so much! Iâm keeping my fingers crossed. 
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Thatâs another jewel in Dr. Cognettiâs crown! How great to know he/his office staff really put themselves out to ensure you get the care you need, @karen1! Iâm glad your surgery is coming up soon!
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Thank you! Heading to Philly in the morning. Surgery check in is 5:30 am Monday. Getting pretty nervous.
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You got this! You will be so happy to have it behind you. Definitely keeping you in my thoughts!
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Praying for you & sending you a hugâŚ
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Day two post left styloidectomy from Dr. Cognetti at Thomas Jefferson University Hospital in Philadelphia. They were fantastic. I have the expected brusing, swelling, sore. Not horrible. Not taking a lot of pain meds. Incision is pretty small. My bottom lip seems to have a bit of nerve irritation since it isnât moving. The only weird thing is that every time I cough, my neck puffs out quite a bit. I think it might be from internal swelling? Any ideas?
From what I have read, the swelling will probably get worse over the next few days before it gets better. Is that correct? He removed my left styloid that was a little over 3 cm. He said my left internal jugular should have no trouble reopening. We will know for sure with follow up imaging. I have my post op follow up next week.
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I suspect what youâre seeing in your neck when you cough is just what you said - you have swelling inside your neck that exacerbates the outward push of your neck muscles when you cough. I can imagine coughing isnât very comfy right now so I hope you donât need to do it very often.
Iâm really glad youâre doing so well at this point. Youâre correct, days 3-5 are when post op swelling peaks. By the end of the second week youâll likely notice gradual positive changes occurring (based on my experience). Keep icing your neck & keep pain meds close at hand for the next several days. Stopping pain meds too soon can allow pain to ramp up. Trying to get back on top of pain can take time & misery during the process so be aware of how youâre feeling & donât try to be heroic by letting too much time lapse between doses.
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Good that youâve had your surgery & it wasnât horrendous! I hope that you heal quickly & soon feel the benefits. Youâre right about the swelling & I agree with @Isaiah_40_31 about the likely cause of your neck puffing 
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