MVD #2 Diary - Sandy Sanders
My initial email to Ann was sent in October 2007. Sharon, the scheduler, contacted me in November for an appointment with Dr. Raymond Sekula in December 2007 as Dr. Jannetta was going to be out of the country. I explained that I preferred to wait until Dr. Jannetta returned. So I originally was scheduled to see Dr. Jannetta on February 12 and to have surgery on the 13th. However, due to a convention that the physicians were attending, that was changed and I was scheduled to see Dr. Sekula on the 11th and to have surgery with both doctors on the 14th. I also was given a list of pre-op diagnostics to have done prior to going to Pittsburgh as well as a few studies that would be performed at Allegheny General Hospital (AGH). Even though reports of all of the pre-op studies were faxed to Sharon two weeks prior to surgery, I made sure I had a copy of everything to carry with me to Pittsburgh. Those studies included MRI, pre-op physical, CXR, EKG, CBC with diff., Platelet Estimate, CMP, PT, PTT, Urinalysis and a hearing test. The tests to be performed at AGH were arranged by Ann and Sharon.
Monday, February 11, 2008 - Date of Departure:
Awake at 5:30 a.m. to finish last minute packing, shower and leave home by 8:30 to pick up my daughter, Jackie who is driving my husband, Wayne and I to the airport. Even though we live only four hours from Pittsburgh, we decided to fly and use the hotel shuttle back and forth to the hospital to avoid driving through a city that we are not familiar with and to avoid the hassle of parking, etc. Check-in at the airport goes smoothly. Our flight is at 12:00 with arrival in Pittsburgh at 1:00. We are to go immediately to the office to meet with Dr. Sekula at 2:00 p.m. At 11:30 I notice they have posted our flight is delayed an hour. I called and left a message on Sharon's voice mail. The plane ends up being an hour and a half late. We eventually land in Pittsburgh at 2:15. I called Sharon as we were descending. She tells me to take a deep breath, that Dr. Sekula got called into an emergency surgery so just get the hotel shuttle and come to the office. After finding the baggage claim and waiting for the hotel shuttle (an hour later) it was 4:00 before we got to the office. The receptionist, Sarah, was the only one there. Just about that time Sharon calls on my cell and instructs me to come back Wednesday morning at 10:00 a.m. to see Dr. Sekula. When I reminded her that I have EMG scheduled for 10:00 a.m. on Wednesday she told me to come to the office as soon as I was done in that department. I immediately called the Hampton Greentree to try and catch the shuttle but too late. We had to wait about another forty minutes for the shuttle to return. We talk to our driver, Ernie on the way back about snow in Pittsburgh. He tells us they haven't had any more than what you could dust off with a broom. Once we were at the hotel I made arrangements for shuttle service to AGH for ABR on 2/12 and EMG and appointment with Dr. Sekula on 2/13 and surgery on 2/14. The evening news warns of 2-4 inches of wintry mix beginning tomorrow morning through tomorrow afternoon. Great! At 9:00 PM it's snowing already- a perfect ending to a perfect day. That night on the phone with my other daughter, Jamie, I was told, "Mom, let everything negative get out of the way now so Thursday will be all good."
Tuesday, February 12, 2008: - Audiogram:
Wake up to schools closed in Pittsburgh and the surrounding areas. It has snowed all night, is still snowing and is expected to continue to snow into the evening with another band of snow tomorrow morning. Tomorrow's accumulation is not expected to be as bad as today’s. I check with the front desk when Wayne and I go down for breakfast about whether or not the shuttle would be running. I'm told, "Just have to wait and see." I called the Balance and Hearing Center to confirm my appointment. We are to register at 1:30 and the test is at 2:00. I hope I can get there. We leave the hotel on the 12:00 shuttle to allow plenty of time. It's usually a twenty minute ride from the Hampton Greentree to AGH but the roads are snow covered and slushy. We did not pass any snow removal equipment during our commute to the hospital. Our driver leaves us off at the Sandusky entrance and gives us very clear instructions regarding pick-up. We get instructions from the information desk to Elevator C and as we are finding our way we are stopped twice with offers of help. Finally one gentleman decides to provide a personal escort to the Hearing Center. We discover he has a son that lives in Maryland. We arrive at the center a half an hour ahead of schedule. We're only there a few minutes when Jill takes me back. The Audiogram takes about 15 minutes and the audio brain response took about 25 minutes. We were done by 2:15. Jill tells me she'll fax a report to Dr. Jannetta this afternoon. Wayne and I went to the cafeteria on the second floor for lunch. They have a large variety to select from. We had a hot entree for lunch and took back sandwiches and a salad for that evening so we wouldn't have to venture out. The snow and sleet have stopped but its bitter cold and cloudy. After we return to the hotel, I change our shuttle time for tomorrow morning from 9:00 to 8:00 to allow for extra travel time due to more snow in the forecast and probable impaired road conditions.
Wednesday, February 13, 2008 - EMG-NCS, x-ray and pre-op consultation:
6:00a.m. Awake to more snow. At 7:30 Wayne and I go downstairs for breakfast and I let Bob at the desk know we're here for the 8:00 shuttle. He tells me Karen, the driver, called to say the roads are bad and she may be a little late. When Karen arrives she announces to the five travelers that she wants to wait 5-10 minutes as traffic is backed up. It took us approximately 40 minutes to get to the hospital. One young woman was late for a job interview. We dropped her off first and then proceeded to the Sandusky entrance. Once inside I had to call Sharon because I had failed to ask where I needed to go for the EMG study. I first had to go to Snyder registration in the main lobby then take the elevator to 01 to EMG. Once again, we were early but the staff welcomed us and took me back. Dr. Yoder and Dr. Small performed the "EMG-NCS". (They do electrical monitoring, looking for abnormal neural conduction and crosstalk, termed "lateral spread"). Dr. Yoder and Dr. Small were very kind and promised to get the information to Dr. Jannetta that afternoon. At 11:15 we headed to see Dr. Sekula. Upon arrival, we were informed he was in the OR, to go have some lunch and come back at 1:00.1:00p.m. There really is a Dr. Sekula! Finally get to meet Ann and Dr. Sekula. I love him. He makes me feel optimistic that I have a chance to be spasm free. He does caution me though that he does not know what he may find in the way of scar tissue, etc. from my previous MVD. He seems surprised after examining my previous incision site and writes a script for a skull/ mastoid x-ray. He tells me they may need to make a new incision. He also tells me they do not use a lumbar drain so I should not have to worry about a spinal fluid leak like I experienced after the first MVD. He wrote me three prescriptions that he encouraged me to have filled before surgery and before returning to Maryland. One for pain, one for nausea, and one for sleep; I'm glad I listened to him and had them filled. While I didn't need the whole prescription, I did use each one. At 2:30 Wayne and I are wrapping things up with Ann when she confirms that I'm number one on the OR schedule tomorrow morning. I have to be at the hospital at 5:00 a.m. But she tells me to still call the number in the handbook and follow the instructions. At 2:25 Wayne and I head for the x-ray department. Again, registration is very organized and timely. The technicians are very kind and professional. They explain to me that a new policy had just come out and they no longer take mastoid x-rays. I show them my scar, explain I have a titanium plate in my head and am scheduled for surgery tomorrow morning and that Dr. Sekula does not know what he is cutting into. They agree to break the new rule and go ahead and take the film. I make my call to the Ambulatory Care Center and confirmed I needed to be at the hospital at 5:00 a.m. I answered a few questions for the nurse to expedite the check in process in the morning. After arriving back at the Sandusky entrance to meet the shuttle, I asked the receptionist if I would be able to get in that entrance at 5:00a.m. She explained if security wasn't there when I arrived that there was a phone beside the door. Since AGH does not have a pharmacy, we asked our shuttle driver to drop us off at Wal-Mart to have my prescriptions filled. It was 5:30 by the time we got back to the hotel. It was a very long day. I made arrangements for John, tomorrow's driver, to pick us up at 4:30 am. Chris, the desk clerk recommended a wakeup call and I thanked her. I told her my two daughters were expected to arrive tonight and with 3 women sharing one bathroom we better make that call for 3:30.
Thursday, February 14, 2008 - "MVD-Day":
3:30a.m. The phone rings and I turn off the alarm before it has a chance to sound. Since I didn't need time for make-up, I let my daughters use the bathroom first. I kept reminding myself not to drink any water when I brushed my teeth. When we arrive in the lobby, our driver, John, is there, ready to go. It's the smoothest ride yet to AGH. John leaves us off at the Sandusky entrance and he wishes me "Good Luck." Even though it’s only 4:50 a.m. the doors open up; we proceed to the main lobby and take elevator "E" to the 11th floor. After signing in we take a seat in the waiting room. I was amazed at the number of folks there already. A nurse came in and gave instructions for both patients and family/friends to follow. When my name was called, I went to the admitting area where a nurse took my vital signs and weight and then led me to my room where I changed into a patient gown and TED hose. A physician's assistant brought the operation consent for me to sign. Another nurse drew more blood for type and cross match. My family comes back and joined me. By 7:00 a.m. I was wheeled in a bed to the Operating Room holding room. There I met Dr. Liu, the anesthesiologist and I explained the difficulties I had following my first MVD with the spinal fluid leak and vertigo. She suggested a Scopolamine patch and turned me over to the very capable hands of her associate Dr. Raj. He explained everything step- by-step and started my IV. He applied the patch behind my right ear- the non-operative side. At approximately 7:30 Dr. Raj rolled me into the OR. Dr. Sekula stopped by and said "Good Morning" and I remember asking if Dr. Jannetta was going to be there and he said "yes." Then Dr. Raj came by and said I'm going to give you something to help you relax and shot something in my IV. The next thing I remember is waking up back in my room with my family at my bedside. My daughter said the surgery took about 3 hours. I returned to my room between 3:00-3:30. The nurses told my family I was in and out of it in the recovery room but I have no recollection of that at all. When I woke up I remember asking "Did it work?" My daughters were smiling and nodding. The nurse wanted me to stay awake but all I wanted to do was sleep. I'm not sure at what point they made me aware that I had lost my hearing in my left ear. I remember walking to the bathroom twice and feeling nauseous. I remember being offered various items to eat and drink but nothing was appealing. I had some bleeding from my incision which, Dr. Sekula repaired at the bedside by replacing a few staples with sutures. My family stayed until visiting hours ended. My daughter stated she felt very comfortable leaving that night knowing nurse "Cindy" was on duty. I remember during the night a male nurse took my vital signs one time. Other than that I must have slept all night.
Friday, February 15, 2008 - The Day After:
Dr. Sekula came in and took me for a walk down the hall. He laughed and told me “You don’t have to go so fast.” I felt like he was the one dragging me! We just smiled at each other. He told me I could go back to the hotel room that afternoon and follow-up with him at the office on Monday (2/18). I remember asking him if he thought I was at risk for the spasms to return. He told me he thought the chances were very low. He was very concerned about my hearing loss. I told him this was a risk I was willing to take to be SPASM FREE and I had no regrets. I am weak and have no appetite but there is no reason to stay in the hospital. I just need to rest. My nurse today, Tiffany, gave me a bed bath and helped me prepare for discharge. She reviewed the written discharge instructions with me. My family arrived and took me via wheelchair to the Sandusky entrance where we waited for the shuttle back to the Hampton Greentree. During this time I called Southwest and changed Wayne and my flight time for Monday to a later flight due to my follow-up appointment at 12:30 and our original flight was at 1:00. Unfortunately the next flight to BWI isn’t until 6:50 p.m.
Saturday, February 16 and Sunday, February 17 - 2 & 3 Days Post-op:
Over the weekend I basically slept. I ate very little due to some persistent nausea. The Compazine prescribed by Dr. Sekula did help. I tried to have breakfast downstairs with my family on Saturday but there were so many weekend travelers that I found the noise level and being upright very uncomfortable and I had to return to the room. The thought of sitting around the airport for hours following my follow-up appointment on Monday was making me nervous. My daughters changed their plans to leave on Sunday and stayed over so Wayne and I could drive back to Maryland with them following my appointment.
Monday, February 18, 2008 - 4 Days Post-op:
I finally get to meet Dr. Jannetta! Up until now I had not met him due to scheduling conflicts. My family had met him following the surgery and was very impressed. When he greeted me he threw his arms around me and said, “My dear, I know you intimately.” This legendary, brilliant neurosurgeon was caressing me like a daughter. I didn’t feel like just another patient. I felt like I really mattered to him. He put me through the typical facial routine with no spasms. Dr. Sekula reviewed again what he had found during the surgery. The way I understand it, because the vessel compressing my nerve was so large, the surgeon during my first MVD chose to lay a band of Teflon between the vessel and the nerve as opposed to fluffing the fiber. This band eventually created more pressure and scar tissue developed between my auditory and facial nerves. Drs. Jannetta and Sekula could not proceed without removing this scar tissue which is the reason for my hearing loss. My family and I asked about the other surgeon’s technique and would/should he be contacted to prevent another patient from this same outcome. Dr. Sekula commented that the other neurosurgeon is well known for his success in the area of brain aneurysms, does not perform as many MVD's but has had successful MVD outcomes. This is true and why I went to him for my first MVD. After reviewing my discharge instructions, he tells me I do not need to come back but that they would like to hear from me in a couple months as to how I am doing. I again asked about the risks of the spasms returning and he again tells me he feels the chances are low. His last words to me as he is giving me a hug are, “I’m glad you came here,” to which I replied, “I’m glad you were here. I feel like you have given me my life back.” After taking the shuttle back to the hotel we hit the road for Maryland. Since it was President’s Day traffic was light and despite some light rain and snow showers we made it to the girls’ home by 6:00 p.m. After a quick hello to my grandson, Logan, Wayne and I headed for home.My sister and brother-in-law stayed with me during the first week and Wayne went back to work. I was very weak and still had issues with nausea that gradually subsided. On Thursday, February 21, 2008, one week post surgery, the bones on the left side of my face ached and felt bruised like someone had punched me with their fist. By that evening most of the discomfort had settled into my chin. I held a heating pad on my chin. On Friday, February 21, 2008 I noticed I could not run my tongue around my lips. My smile was no longer symmetrical. I only had half a smile. I couldn’t close my left eye. Was this Bell’s palsy I asked myself? I called Ann on February 25, 2008. She said it was unusual to have a delayed Bell’s palsy after surgery but to expect it to be temporary and to keep them posted. By March 11, 2008 my smile returned and I was able to lick my lips again. I believe I may have induced some swelling of the nerve when I applied the heating pad to my face.
Four (4) Weeks Post-op:
It has been approximately four weeks since my surgery. I still feel weak but each day is better. Every now and then I feel a little flutter in my eye and it scares me but I tell myself that I cannot live in fear of that demon returning. I thank God everyday for being with us in that OR and blessing me with this outcome. I am looking forward to getting back to work and to my church.