MVD Diary - Marife Maliksi

Surgery performed by: Dr. John Loeser
Surgical Location: Univ. of Washington Medical Center, Seattle, WA
Surgery Date: September 8, 2000

Diary prepared by: Marife Maliksi
Date diary finalized: October, 2000

In 1983, I was diagnosed with Hemifacial Spasm (on the right side) at the Columbia University Hospital in New York. At the time, the only remedy offered to me was botox injections, which I almost immediately declined. From that time, through our relocation to Southeast Asia in 1990, I sought no further treatment for HFS. By the early 1990s, the twitching below my right eye had given way to near violent facial contortions that was affecting my speech and (coincidentally?) stiff neck symptoms on a regular basis. Traditional western medical approaches for HFS in the Philippines, where we were living at that time, were scanty at best. However, I did benefit from periodic visits with a Chinese accupressure specialist.

We returned to the United States in August of 1999 and settled in Seattle, Washington. My husband and I inquired about the Neurosurgery facilities at the University of Washington Medical Center as the thought of seeking treatment either at the universities of Pittsburgh and Florida seemed logistically inaccessible to us what with three children. It was at this time that I was referred to Dr. John Loeser (pronounced low-zhiere).

My husband and I met with Dr. Loeser in July 2000. He concurred that I indeed had Hemifacial Spasm symptoms after analyzing a series of movements he asked me to perform. He then discussed my alternatives. As I'd informed him that I'd previously declined botox injections at Columbia University Hospital, he opened with this first saying that the procedure involved with the shots had improved vastly in the last few years. He informed me that the doctors who apply botox now have advanced procedures with a higher degree of accuracy in pinpointing where the shots should be administered. While this procedure would often be prescribed twice a year, each session required about an hour as multiple shots are involved. Dr. Loeser recommended this. It was my husband who persisted with the surgical inquiry. Only after this did Dr. Loeser agree to discuss this option.

Dr. Loeser confirmed that he and other doctors at the University perform microvascular decompression. The MVD was performed with a team that would monitor such things as hearing, et al. I know that members of our Circle of Friends have often discussed this. Dr. Loeser was quick to point out that monitoring does not preclude the probability of damage or injury. This attitude is one that my husband and I greatly appreciated, as there clearly was no attempt to gloss over risk factors. The doctor continued with what the process involved. Surgery would be scheduled on a Friday morning after a series of tests within a week of that event. All tests were outpatient, in my case. If no complications arose, I could leave the hospital by Sunday, rest at home for a week, and could return to work provided that this was largely restricted to administrative type.

We called Dr. Loeser's office a month later. Surgery was then scheduled for the first week of September.

Following are information on the surgery.

• Blood test and anesthesia evaluation
• X-Ray
• EKG/ECG
• MRI of brain

• MRA - Head and Neck
• Audio Testing

5:45 a.m. Check in at University of Washington Medical Center

6:00 a.m. Pre-Surgery waiting area

7:00 a.m. Room where patients are prepared for surgery - MRA needles/wires inserted
on my head, face, and jaw - Anesthesia administered

7:30 a.m. Operating room - Monitors used during surgery: MRA, Hearing, Anesthesia, and Endoscope. Surgery was about four hours. My scalp was shaved around the area of the incision. I am sorry to disappoint some of you, but I cannot be classified under the "plugged heads" membership. My procedure involved a thinning of the skull area where the compression was located. This will be a permanent condition of my skull, sort of like a baby's soft spot, as the hole was not "plugged". The doctor immediately found the artery compressing my 7th nerve.

11:55 a.m. My husband received the great news from Dr. Loeser that the surgery was over without any complications. He was asked to return to the hospital no earlier than 3:00 p.m., as I would be kept in the Recovery Room until about that time.

Recovery Room:
I was in the recovery room for about three hours. Dr. Loeser and about a dozen different people talked to me and asked me several questions repeatedly, just to make sure that I was aware of everything that was going on, despite being groggy. I remember having a gigantic headache, which I relayed to them and I think they said they would give me morphine. I also remember throwing up. From there I was released to Intensive Care Unit, which is still procedural.

Intensive Care Unit:
It was in the ICU that I was reunited with my husband and our three children. I had leg wraps (for circulation and to prevent clotting), catheter, oxygen tape on my nose, and IV. I was not groggy from anesthesia anymore but I often napped. I was very hungry but could not eat a lot when food was brought to me. I had pain on the incision towards the evening and painkiller was given to me by IV and orally. Before they left that evening, they witnessed me feeding myself a little gelatin. This is where I stayed overnight.

The following morning, Saturday, as scheduled, I was moved to a regular room. The leg wraps were removed. By the afternoon, I was able to walk from my bed to a chair where I sat up most of the afternoon and had a meal. That day I was attending to my own grooming needs. I couldn't move freely because of the IV and catheter, but I felt so much better. Some pain on the incision, but not bad.

Sunday morning, my husband said that our biggest problem would likely be the traffic building up around Husky Stadium (right beside the hospital) for the Seattle Seahawks football game.

Dr. Loeser called on me that morning, pronounced the surgery a success, signed my release, and asked me to call him 3-4 weeks after surgery to confirm that everything is okay.

The doctor pointed out that there was still a groove where the compressing artery had terrorized the facial nerve for the near two decades that I had HFS. It is his opinion that the nerve should round back into shape eventually, and all mild twitching will most probably cease. Once again, he mentioned that there have been cases where arteries have recompressed, and here succeeding surgeries have had diminishing success.

I left the hospital before Sunday noon with an appointment the following Friday for suture removal and instructions not to shampoo my hair until then.

At home, I took a prescribed painkiller sparingly, and slept most of the time during the first three days.

I had a hoarse voice on and off due to the tube inserted down my throat for oxygen during surgery. My right ear felt like it had lots of liquid. My right ear and part of my head around the incision were still numb. Some pain on the incision, headache sometimes, both not too bad. I napped when I felt tired and sleepy.

Sutures were taken out one week after surgery. According to the internist, sutures are easier to take out 7 days after surgery; longer than that, the sutures tend to wedge deeper into the skin.

I was able to then shampoo my hair (hurrah!).

My sister arrived from overseas ostensibly to care for me, but all we did was go shopping and I took her around to see the area.

Everything was back to normal. No dizziness so I drove and did usual chores. Some pain on the incision and headaches, but not bad.

Everything's definitely back to normal! More pain on the incision area (not too bad

though) - is it because feeling is slowly coming back around that area, which was very numb after surgery? So far no more twitches (I’m crossing my fingers!).

Now I smile abundantly, as my eldest son and husband have commented that I even look younger as my facial skin no longer has that taut and stressed appearance.

Seattle is a beautiful city, and the University's location one of the most scenic with views of Lake Washington and Mt. Rainier.

I wish all of you the best, and hope that this has been of some value to you and your loved ones.