ANA Discussion Forum

Pre-Treatment Options => Pre-Treatment Options => Topic started by: Mei Mei on June 01, 2012, 06:48:36 pm

Title: To have Titanium mesh or NOT
Post by: Mei Mei on June 01, 2012, 06:48:36 pm
Dear Friends and PreOps,
In March I had another surgery and I posted asking if anyone had ever heard of methylmethacrylate I received a very interesting and thought provoking answer from MK or Marianna from Toronto, Canada and the surgery was at Vancouver General:


I haven't heard about the procedure that you mentioned, but my neurosurgeon uses methylmethacrylate "bone cement" to put back the piece of the skull that he removes during retrosigmoid, without using a titanium mesh at all. That way it seems that he avoids lots of the related headache side-effects. It seems to me that what you describe is somewhat similar.

Good luck with your procedure and I hope you will find relief.

Marianna


When I asked my surgeon Dr. Frederic Schwartz about not using Titanium mesh but actually using your original skull bone to close up, he replied that's because they don't have as much money as we do in the United States.   ????
My PT said well it was paid for by your insurance company  ????

Since when is expensive always better?   Wouldn't you want to have your original skull bone piece instead of something foreign used to close up?   Just take a look at the Headache section of the Forum and notice all the complications of having something foreign in you head.   The last few months as I watch TV, I see a commercial from some big Malpractice firm asking if you've had Titanium mesh for Gynecologic surgery.   So it's not a problem with AN patients but with others.    I've only known two people that have not had Titanium mesh put in to replace their skull:   Tod down in Richmond at the Virginia Commonwealth University Medical Center and Marianna at the Vancouver General.   They don't have Post Op Headaches.   

Speaking from my side of the Posties, you don't want to EVER have these headaches.   They are worse than migraines and some on the Forum have talked of suicide.   Maybe you might get headaches from occipital nerve damage and Dr. Ducic at Georgetown can fix that.  He's good at that.   Let's hope that doesn't happen to you.   You want to come out of the surgery with the least possible post op damage.

With your list of questions when you go surgeon shopping, include the question of whether they would be willing to put back the bone your mother and father gave you and not put it in the trash.   Would they be willing to NOT use Titanium mesh as they do in POOR impoverished but better off Canada and Richmond, VA?   If not, my best advice to you is to pick yourself up along with your insurance card and continue shopping until you hear what you want to hear.

Titanium is expensive and more expensive than gold.  The only winners in this situation are the Titanium makers of America.   What I wish for all of you is that you come out a winner instead of the Titanium lobby.

In good health,
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: leapyrtwins on June 01, 2012, 08:14:22 pm
Mei Mei -

it is my understanding from talking to my surgeons that I have both titanium mesh and the piece of my skull that was removed during my surgery.  The way my neurosurgeon described it to me, he cut a "window" in my skull and this "window" was replaced after my AN was removed - before I was stitched up.

The titanium mesh I have is in the place where my AN used to be (along with some of my belly fat).  I also have a titanium plate in my surgical area along with titanium screws.  I've never had a headache associated with my AN surgery.

Jan
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 01, 2012, 10:51:49 pm
I'm scared about the idea of putting anything foreign in my head, too, but I was under the impression that the headaches from retrosigmoid surgery were due to bone dust in the CSF.    ???

Liz

Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 01, 2012, 10:56:19 pm
Jan, did they use titanium mesh to rebuild the IAC?  Otherwise, I'm not understanding why they would put titanium mesh where your AN was.

I'm scared to turn my head over to surgeons, when I don't know exactly what they are going to do to me.  :-\

Liz
Title: Re: To have Titanium mesh or NOT
Post by: mindyandy on June 02, 2012, 04:53:20 am
I have the mesh too. The only question that I asked is are people allergic to it? I was told no. I had Retrosigmoid and I have no headaches from my AN surgery.
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 02, 2012, 08:21:48 am
My MRI shows that the mesh is entrapping the nerves.   This is what it says in the radiology report.   The radiologist called me into his office to talk with me about this.   No radiologist has ever done this.    He said I've been watching you for the past two years and this must be driving you crazy.    He promised to research the problem and get back to me.   I was  so touched.   The nerves were cut in a two hour surgery a year ago.   It helped tremendously from the middle to the top of my head but the sub occipital area and the right side of my neck is still stinging, burning and in constant pain.   I can't got out to a restaurant and talk with someone for more than half an hour.    This mesh has been my Achilles heel ever since my retrosigmoid surgery.    No bone was placed.    That's why I was on life support after my occipital nerve block in Dec. 2010.

I'm going for a cervical nerve block. on June 13th and let your know how it goes.     

Jan, it looks like you had a great surgeon.     

Write to Tod to ask him about his 32 hour surgery in 2010.   I'm sure he said he has no mesh and he also was headache free.
I'm still on the conservative side    If I were a pre op. now, I would err on the side of caution and find someone that would  not use the mesh like Tod.     My tumor was only one cm and Tod's was over 5 hence the 32 hour surgery.      Look to Tod and Marianna up in Canada.    THey are doing well and I'm not.

Sincerely,
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 02, 2012, 08:34:57 am
I'm scared about the idea of putting anything foreign in my head, too, but I was under the impression that the headaches from retrosigmoid surgery were due to bone dust in the CSF.    ???

Liz

I also had retros. and that is what I have read was the bone dust if they are not doing the right thing with the gel foam to absorb it all can cause problems ... I have the titanium screws coming up to the surface of my huge incision and it bothers me along with constant headaches. But Liz you are going to HEI and so many many success stories I am sure you are going to be find.

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 02, 2012, 08:42:33 am
Mei Mei -

it is my understanding from talking to my surgeons that I have both titanium mesh and the piece of my skull that was removed during my surgery.  The way my neurosurgeon described it to me, he cut a "window" in my skull and this "window" was replaced after my AN was removed - before I was stitched up.

The titanium mesh I have is in the place where my AN used to be (along with some of my belly fat).  I also have a titanium plate in my surgical area along with titanium screws.  I've never had a headache associated with my AN surgery.

Jan

Jan was it you that had the screws removed and showed a photo of them ? I went to a new surgeon and he said to take mine out would be a very complex surgery I am confused because his Oto partner stated it was easy and could be done in the office I am now assuming he just does not want to fix want another surgeon did ??

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 02, 2012, 08:54:29 am
We have a lot here in the Maryland DC VA and even further that went to Hopkins and come out with the same headaches.   They get treated  at Georgetown successfully.   These are small tumors with the retrosigmoid.    The doctors in DC said it wasn't necessary.   Dr. Friedman offered me Middle Fossa and so did three other doctors.   Right before I went under at my last surgery to fix this at GW, the resident asked me the size of my tumor and I told him it was 1 cm.   The resident looked at my doctor and said it was a small tumor and they both shook their heads.   What I'm saying is that this was not necessary.

What my main question is why do they even bother with the mesh when Tod had a 5 cm  without the mesh.    It's a big question.

Surgery was possible before the development of the mesh and in Canada.     What can't we have a choice.   Is the mesh absolutely necessary?????????

Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: leapyrtwins on June 02, 2012, 11:49:56 am
Jan was it you that had the screws removed and showed a photo of them ?

I had one of the screws removed - but only because it was very close to the surface of my scalp (as the result of my BAHA implant surgery).

My BAHA site is directly on top of my AN surgical site and my doc told me the screw might become an issue.  About 2 1/2 years after my implant, it got to the point where I was scraping my fingertip the screw when I put on my processor. 

So I asked my doc to remove it - and he did during a very short outpatient procedure.  I was awake (lidocaine in my skull) and it took about five minutes once I was prepped; he used a screwdriver.

The screw is extremely tiny, and yes, I did post a picture of it on the Forum but now I can't find it - so here it is again:

(http://i219.photobucket.com/albums/cc207/leapyrtwins/100_0693A.jpg)

The screw is next to a dime. 

Jan
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 02, 2012, 01:07:55 pm
Jan was it you that had the screws removed and showed a photo of them ?

I had one of the screws removed - but only because it was very close to the surface of my scalp (as the result of my BAHA implant surgery).

My BAHA site is directly on top of my AN surgical site and my doc told me the screw might become an issue.  About 2 1/2 years after my implant, it got to the point where I was scraping my fingertip the screw when I put on my processor. 

So I asked my doc to remove it - and he did during a very short outpatient procedure.  I was awake (lidocaine in my skull) and it took about five minutes once I was prepped; he used a screwdriver.

The screw is extremely tiny, and yes, I did post a picture of it on the Forum but now I can't find it - so here it is again:

(http://i219.photobucket.com/albums/cc207/leapyrtwins/100_0693A.jpg)

The screw is next to a dime. 

Jan

I thought I remembered that just that this surgeon did not want to fix another persons work said it is very complicated and his partner said it was easy. Just have to find another surgeon it is up at the surface above the incisions indentation so even I can do it myself...lol....rather not, not sure if it is a flat head or Philips ???

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: mk on June 02, 2012, 07:04:19 pm

When I asked my surgeon Dr. Frederic Schwartz about not using Titanium mesh but actually using your original skull bone to close up, he replied that's because they don't have as much money as we do in the United States.   ????
My PT said well it was paid for by your insurance company  ????

Since when is expensive always better?   

Mei Mei,

This has nothing to do with cost, it depends on the surgeon. My understanding is that the titanium mesh is the standard technique everywhere, including Canada. I think that the reason for using it is to provide a "scaffold" to aid bone regeneration. As far as I know Dr. Akagami at VGH is the only neurosurgeon who doesn't use it in Canada. Dr. Akagami has developed quite a few unique procedures (he does retrosigmoid using a different incision than the typical one, uses gravity for brain retraction, uses the bone cement etc). He achieves very high success rates with his techniques. I think that the fact that he uses a different incision, might make it more feasible to replace the bone, without the mesh.
The titanium mesh does occasionally result in some problems, ranging from some minor discomfort, requiring minor readjustment of the screws to the more severe nerve entrapment like you are experiencing. Other reasons for headaches with retrosigmoid are damage to the occipital nerve, and the bone dust, as mentioned in this thread. But from what I have seen here, at the hands of experienced neurosurgeons, as in HEI, it is usually not a problem.

AN surgery has its risks, as we all know, and there are no guarantees.  Unfortunately there is always a percentage of patients who will experience problems. I do hope that you will eventually find some relief for yours.

Marianna

Title: Re: To have Titanium mesh or NOT
Post by: leapyrtwins on June 03, 2012, 12:20:27 pm
pjb -

the surgery to remove my screw very easy.  I was surprised that my doc didn't just do it in his office, but he said it wasn't a sterile environment.  Because the screw was so close to the surface of my skin, the procedure wasn't that invasive.  He simply made a cut in my skin then used the screwdriver to remove the screw.  I didn't ask to see the screwdriver - wish I would have.

I think you are right in your assumption that the surgeon who said it was "complex" just didn't want to do it.  I'd go with the surgeon who said it was easy.

Jan
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 03, 2012, 02:34:52 pm
pjb -

the surgery to remove my screw very easy.  I was surprised that my doc didn't just do it in his office, but he said it wasn't a sterile environment.  Because the screw was so close to the surface of my skin, the procedure wasn't that invasive.  He simply made a cut in my skin then used the screwdriver to remove the screw.  I didn't ask to see the screwdriver - wish I would have.

I think you are right in your assumption that the surgeon who said it was "complex" just didn't want to do it.  I'd go with the surgeon who said it was easy.

Jan

Thank you Jan that is what I figured when he said that I wish I would have had a camera I could imagine what my face looked when he said that my daughter was at both appointments with me so I know for sure of what I heard .. I am sure with the discomfort that I am feeling this is not normal he also said that the brain takes time to heal between 10 to 15 years but I do not think with those screws up at the surface is going to get any better !.

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: Tod on June 03, 2012, 05:50:36 pm
Mei Mei, I wouldn't use me as much of example of anything other than having a long surgery. There are a number of people who claim that I don't feel pain (or that I am an unfeeling *******, I'm not clear which :) ). I do in fact feel pain, I don't believe I have headaches associated with my surgery or FSR as any headaches I have now are no different than what I had at any other time in my life.

Seriously though, I'm not sure the causes of headaches in general are understood well enough to make strong causative relationships between surgery types and headaches as there are simply far too many variables at play. I also think the available data are too poorly assembled and unavailable for most of us to any real research. The selection of people of folks active on the forum is most likely not representative of the AN population and so any correlations we make are not generalizable.

Mei Mei, I wish you could find some relief for your pain, I really do. If nothing else, you should take comfort in the fact that your experience makes the case as to why wait and watch might be the best option for those with small tumors.

-Tod
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 04, 2012, 08:18:19 am
Mei Mei, I wouldn't use me as much of example of anything other than having a long surgery. There are a number of people who claim that I don't feel pain (or that I am an unfeeling *******, I'm not clear which :) ). I do in fact feel pain, I don't believe I have headaches associated with my surgery or FSR as any headaches I have now are no different than what I had at any other time in my life.

Seriously though, I'm not sure the causes of headaches in general are understood well enough to make strong causative relationships between surgery types and headaches as there are simply far too many variables at play. I also think the available data are too poorly assembled and unavailable for most of us to any real research. The selection of people of folks active on the forum is most likely not representative of the AN population and so any correlations we make are not generalizable.

Mei Mei, I wish you could find some relief for your pain, I really do. If nothing else, you should take comfort in the fact that your experience makes the case as to why wait and watch might be the best option for those with small tumors.

-Tod

Tod you are right as an older person and with a small tumor 1 cm. I should have done more research and think my choice now would have been W & W and regret the surgery ... there is a Mikey on the W & W and his has not changed in 5 years he has resorted to a healthy life style along with vitamins and now with my 3mm left behind along with numerous post ops problems I am in the that category and have been taking the same vitamins he has and for almost 3 years now thank God my tumor remains the same size and hope it continues to remain the same.

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 04, 2012, 12:03:57 pm
pjb,

I'd love it if you would put your history in your signature, to give us some perspective.  Your surgery was three years ago?  Your tumor was 1cm at the time?  The residual hasn't grown in three years?  (Yea!)  What vitamins are you taking?

For a slightly different perspective, I was in W&W until recently.  The first 6 months, my tumor shrank 1 mm, and I became complacent.  The next 14, it grew aggressively, by over 50%, something I did not at all expect.  I lost most of my hearing during that time and started to have facial symptoms.  I'm not so sure I should have waited, as there may be some damage to my facial nerve, and maybe if I'd had middle fossa at House, I could have saved some of my hearing.  Hopefully, the damage to my facial nerve is reversible.

Personally, I think the most important choice is treatment team.  That said, I hope I don't end up with residual problems, now that I've made my decision to go to House for translab.  There are drawbacks to every choice, surgery, radiation, and even W&W.  None of us can predict the future.

Mei Mei, I am praying that things get much better for you and soon.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 05, 2012, 07:16:27 am
pjb,

I'd love it if you would put your history in your signature, to give us some perspective.  Your surgery was three years ago?  Your tumor was 1cm at the time?  The residual hasn't grown in three years?  (Yea!)  What vitamins are you taking?

For a slightly different perspective, I was in W&W until recently.  The first 6 months, my tumor shrank 1 mm, and I became complacent.  The next 14, it grew aggressively, by over 50%, something I did not at all expect.  I lost most of my hearing during that time and started to have facial symptoms.  I'm not so sure I should have waited, as there may be some damage to my facial nerve, and maybe if I'd had middle fossa at House, I could have saved some of my hearing.  Hopefully, the damage to my facial nerve is reversible.

Personally, I think the most important choice is treatment team.  That said, I hope I don't end up with residual problems, now that I've made my decision to go to House for translab.  There are drawbacks to every choice, surgery, radiation, and even W&W.  None of us can predict the future.

Mei Mei, I am praying that things get much better for you and soon.

Liz

I have to try with my information I think if I remember right I was having trouble with that and also my photo I am not very computer savvy ..... The vitamins are numerous NeuroPS, COQ 10, Feverfew, and a whole slew of others I am forgetting if you would like me to PM them I will...Definitely with an AN age is a huge factor in it which I should have done my homework I might have been the lucky one as Mike as to no growth in my 1 cm. But several of my doctors suggested highly for me to have surgery at the time I only had fullness in my ear and perfect hearing.  I started to faint a few times and that is why I had an MRI but the doctors still say fainting is NOT a symptom of an AN. Yes research and a great team is so crucial to ones outcome.

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 05, 2012, 10:54:45 am
pjb,

I'd love it if you would put your history in your signature, to give us some perspective.  Your surgery was three years ago?  Your tumor was 1cm at the time?  The residual hasn't grown in three years?  (Yea!)  What vitamins are you taking?

For a slightly different perspective, I was in W&W until recently.  The first 6 months, my tumor shrank 1 mm, and I became complacent.  The next 14, it grew aggressively, by over 50%, something I did not at all expect.  I lost most of my hearing during that time and started to have facial symptoms.  I'm not so sure I should have waited, as there may be some damage to my facial nerve, and maybe if I'd had middle fossa at House, I could have saved some of my hearing.  Hopefully, the damage to my facial nerve is reversible.

Personally, I think the most important choice is treatment team.  That said, I hope I don't end up with residual problems, now that I've made my decision to go to House for translab.  There are drawbacks to every choice, surgery, radiation, and even W&W.  None of us can predict the future.

Mei Mei, I am praying that things get much better for you and soon.

Liz

I have to try with my information I think if I remember right I was having trouble with that and also my photo I am not very computer savvy ..... The vitamins are numerous NeuroPS, COQ 10, Feverfew, and a whole slew of others I am forgetting if you would like me to PM them I will...Definitely with an AN age is a huge factor in it which I should have done my homework I might have been the lucky one as Mike as to no growth in my 1 cm. But several of my doctors suggested highly for me to have surgery at the time I only had fullness in my ear and perfect hearing.  I started to faint a few times and that is why I had an MRI but the doctors still say fainting is NOT a symptom of an AN. Yes research and a great team is so crucial to ones outcome.

Best Wishes,

Yes, please PM me the supplements you are taking.  I was taking a bunch and my tumor took off.  When it was stable, I was taking only a handful, so I have to wonder if something I added contributed to the accellerated growth.  I want to see what in my list of supplements overlaps yours.

Thanks!
Liz
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 05, 2012, 12:46:38 pm
pjb,

I'd love it if you would put your history in your signature, to give us some perspective.  Your surgery was three years ago?  Your tumor was 1cm at the time?  The residual hasn't grown in three years?  (Yea!)  What vitamins are you taking?

For a slightly different perspective, I was in W&W until recently.  The first 6 months, my tumor shrank 1 mm, and I became complacent.  The next 14, it grew aggressively, by over 50%, something I did not at all expect.  I lost most of my hearing during that time and started to have facial symptoms.  I'm not so sure I should have waited, as there may be some damage to my facial nerve, and maybe if I'd had middle fossa at House, I could have saved some of my hearing.  Hopefully, the damage to my facial nerve is reversible.

Personally, I think the most important choice is treatment team.  That said, I hope I don't end up with residual problems, now that I've made my decision to go to House for translab.  There are drawbacks to every choice, surgery, radiation, and even W&W.  None of us can predict the future.

Mei Mei, I am praying that things get much better for you and soon.

Liz

I have to try with my information I think if I remember right I was having trouble with that and also my photo I am not very computer savvy ..... The vitamins are numerous NeuroPS, COQ 10, Feverfew, and a whole slew of others I am forgetting if you would like me to PM them I will...Definitely with an AN age is a huge factor in it which I should have done my homework I might have been the lucky one as Mike as to no growth in my 1 cm. But several of my doctors suggested highly for me to have surgery at the time I only had fullness in my ear and perfect hearing.  I started to faint a few times and that is why I had an MRI but the doctors still say fainting is NOT a symptom of an AN. Yes research and a great team is so crucial to ones outcome.

Best Wishes,

Yes, please PM me the supplements you are taking.  I was taking a bunch and my tumor took off.  When it was stable, I was taking only a handful, so I have to wonder if something I added contributed to the accellerated growth.  I want to see what in my list of supplements overlaps yours.

Thanks!
Liz

I just saw this and sent you a PM...
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 05, 2012, 05:04:44 pm
Hi Friends,
I haven't been online for a couple of days and am overwhelmed at the response of this thread.   I guess Titanium mesh is a big issue for all of us.   

I myself am in the group that wishes I had watched and waited.   I also wish that I had gone to HEI but was forn, first by having to take care of my father in Maryland and my dog Punky.   Looking back it sounds ridiculous because the 10 days that Dr. Friedman told me to stay was really  not much longer than the 6 days I stayed at Johns Hopkins.   It was something that Dr. Niparko said to me that pushed me over the edge and told myself to go ahead and stay with Hopkins.    After that retrosigmoid surgery there was no turning back in the constant care that I need.   I am on disability now and have 1/2 the monthly salary as before.   I am getting fitted for a bone conduction hearing device this week when before the surgery, I was down only 35 dB.   

Please, all pre-ops, proceed slowly.

To quote Dr. Kondziolka at the Cincinnati Symposium,  regarding age and time:
For those of you on the Watch and Wait list:  what are you waiting for   and
We are always happy to see our 90 year old patients walk in with their parents.

Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 06, 2012, 11:56:23 am
Hi Friends,
I haven't been online for a couple of days and am overwhelmed at the response of this thread.   I guess Titanium mesh is a big issue for all of us.   

I myself am in the group that wishes I had watched and waited.   I also wish that I had gone to HEI but was forn, first by having to take care of my father in Maryland and my dog Punky.   Looking back it sounds ridiculous because the 10 days that Dr. Friedman told me to stay was really  not much longer than the 6 days I stayed at Johns Hopkins.   It was something that Dr. Niparko said to me that pushed me over the edge and told myself to go ahead and stay with Hopkins.    After that retrosigmoid surgery there was no turning back in the constant care that I need.   I am on disability now and have 1/2 the monthly salary as before.   I am getting fitted for a bone conduction hearing device this week when before the surgery, I was down only 35 dB.   

Please, all pre-ops, proceed slowly.

To quote Dr. Kondziolka at the Cincinnati Symposium,  regarding age and time:
For those of you on the Watch and Wait list:  what are you waiting for   and
We are always happy to see our 90 year old patients walk in with their parents.

Mei Mei

Mei Mei,

I am so sorry for all that you are going through.  Thank the gods, you have disability, even if it is only half of what you had before!

If I end up disabled, I will be in very deep doo-doo, as I have no disability insurance in place.

Good luck with your bone conduction device.  What kind are you getting?

A year ago, I only had a mild hearing loss.  My tumor grew aggressively and now I have no serviceable hearing in my AN ear.  I had no idea it could get that bad that quickly.  I guess my denial system is still intact.  :)

It's kind of a damned if you do, damned if you don't scenario.

Hugs,
Liz

Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 06, 2012, 08:17:31 pm
Hi and thank you for your good wishes.
I'm getting a CROS which I don't think is bone conduction.   I also didn't want the Wifi version because that means sending radiation through my head.   He was very understanding and is giving me the wire kind so the device is put on the good ear and a wire goes through your hair to another device in the other ear.   The fitting will be on June 25.   Check my post on the Hearing section . 

The hearing aid should head my neck pain.

I'm sorry you lost all your hearing so quickly.    I remember Dr. Kondziolka saying   for those of you on the watch and wait list, what are you waiting for?   I hope you can come up with  a good solution soon.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 07, 2012, 11:39:30 am
Hi and thank you for your good wishes.
I'm getting a CROS which I don't think is bone conduction.   I also didn't want the Wifi version because that means sending radiation through my head.   He was very understanding and is giving me the wire kind so the device is put on the good ear and a wire goes through your hair to another device in the other ear.   The fitting will be on June 25.   Check my post on the Hearing section . 

The hearing aid should head my neck pain.

I'm sorry you lost all your hearing so quickly.    I remember Dr. Kondziolka saying   for those of you on the watch and wait list, what are you waiting for?   I hope you can come up with  a good solution soon.
Mei Mei

Thanks, Mei Mei.  I am glad to know there is a CROS with a wire.  Are you getting neck pain from trying to keep your head turned toward sounds?

I have the same concerns as you about the CROS wireless device, given that I suspect too many years of cell phone use may have contributed to my developing an AN.  I hope I am wrong about that, but... I am also concerned about a titanium implant, given the autoimmune issues I have already experienced.  Probably, one day, they will prove that fear is what really caused all my health problems.   ;)   Read the book, "Dying to Be Me" by Anita Moojani, and you will know what I mean.

I am scheduled for surgery at House on the 3rd of July, assuming we can get the insurance issues worked out.  House wants me to bring the full deductible required by my primary policy, which is 7 times higher than the one on my secondary policy.  I'm unwilling to give them money that I will later have to try to get back because I don't owe it to them.  Besides, that, I just don't have it.  I hope to get this worked out today, or else I will have to start over figuring out where and when I will have this thing removed from my head.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: lrobie on June 07, 2012, 12:54:40 pm
Liz,

I just skimmed through these posts.  I wouldn't start taking any supplements now with your surgery scheduled for July 3rd.  The paperwork I received said not to take any herbal supplements 2-3 weeks prior to surgery.

Lisa
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 07, 2012, 01:09:43 pm
Liz,

I just skimmed through these posts.  I wouldn't start taking any supplements now with your surgery scheduled for July 3rd.  The paperwork I received said not to take any herbal supplements 2-3 weeks prior to surgery.

Lisa

Thanks, Lisa.  Good point.  I haven't received my packet yet, and I'm getting concerned.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: mindyandy on June 07, 2012, 02:27:34 pm
Liz
I didn't receive my packet till 1 before surgery.

Mindy
Title: Re: To have Titanium mesh or NOT
Post by: lrobie on June 07, 2012, 06:35:21 pm
I remember you saying that you received yours one week prior, Mindy  That's why I made sure to tell the scheduling counselor that I needed mine ASAP because I would be leaving more than a week prior to my surgery.  It did take a couple of weeks after I scheduled, but I did get it.

Lisa
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 07, 2012, 07:45:30 pm
Rita said she'd be sending mine out in a couple of weeks, but it's been a bit longer than that now.  Does she wait until the insurance stuff is settled and a deposit has been sent in to reserve the date?

Liz
Title: Re: To have Titanium mesh or NOT
Post by: lrobie on June 08, 2012, 07:33:30 pm
My surgery counselor (Maria) was not the same person who dealt with the insurance (Yvonne).  Yvonne only verified that House doctors accepted my insurance.  It was up to me to contact St. Vincent's and the anesthesiologists.  I did not have to make a deposit, so I'm not sure what you are referring to.  I also had to contact Sunny, Dr. Friedman's assistant, to get a medical excuse.  So, I've been in contact with several people.  You would think that the surgery counselor should be assigned to take care of all your needs and not have to contact several people to get answers.  I also contacted my insurance company myself just to confirm all coverage.

I would try contacting Rita to ask if it's been mailed or what the hold up is.

Lisa
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 09, 2012, 04:08:05 pm
Lisa,

Did you, or will you, have to pay your deductible up front?  I just sent another note to Rita, this time with my mailing address as I don't recall sending it to her before.  I'm also dealing with Y'Vonne about the insurance for House.  I talked with Wendy at the hospital, and I still need to talk to the anesthesiologist's office, but I have to find the phone number.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 09, 2012, 09:14:06 pm
Wouldn't you be able to get the numbers from the main number at House?
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 09, 2012, 09:21:30 pm
I wonder if they would itemize the bill so you can see how much the Titanium mesh costs.    I never did that and perhaps it is still OK to request a bill that is two years old.   I remember back in 1988 when I had a cervical laminectomy I was sent an itemized bill.   Each Tylenol pill billed to insurance was a whopping $8.00 at Georgetown.   With that many years gone by I'm sure it's much higher.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 10, 2012, 11:37:03 am
I wonder if they would itemize the bill so you can see how much the Titanium mesh costs.    I never did that and perhaps it is still OK to request a bill that is two years old.   I remember back in 1988 when I had a cervical laminectomy I was sent an itemized bill.   Each Tylenol pill billed to insurance was a whopping $8.00 at Georgetown.   With that many years gone by I'm sure it's much higher.
Mei Mei

$8.00 for a Tylenol?  I assume that included the administration of the pill, i.e. the labor cost for the nurse's time?

I don't think they use titanium mesh for translab at House, but I have it on my list of questions for Dr. Slattery.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 10, 2012, 11:38:02 am
Wouldn't you be able to get the numbers from the main number at House?
Mei Mei

I think the hospital sent me the information, but it was in a secured message on their web site that expired after two weeks.  I've sent another request.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: Cheryl R on June 10, 2012, 12:18:17 pm
A few years back my Tylenol was  $2.50.    $2 something anyway which surprised me as thought would be more.       Each hospital is different.
     I don't have mesh in any of my openings which is 3.                 I don't know if a dr would let you have a choice as each has his own protocol with their surgeries.
                                                                  Cheryl R
Title: Re: To have Titanium mesh or NOT
Post by: lrobie on June 11, 2012, 12:58:16 pm
Liz,

I don't have a deductible.  I will need to pay co-pays though for my doctor visits.  The number for anesthesia is #503/372-2794 and there you can ask for Mary. 

I received my packet of information in the mail, if that's what you are referring to.  I had sent emails to House from my work address and the messages went to their spam folders.  I had to resend from my personal email and that worked.

Lisa
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 11, 2012, 04:19:32 pm
Wow, Lisa, that is a different number and name from what I received today.  I have an 800 number and the names and extensions of Evelyn and Sandy.

I may have to pick up the phone and call Rita.  I didn't think about my email not getting through.

Do you know exactly how many pre-op appointments (i.e. co-pays) we will have?

Liz
Title: Re: To have Titanium mesh or NOT
Post by: mindyandy on June 12, 2012, 06:10:15 am
Liz
I had to pay my deductible and my copays. Dr. Stefan's office you pay 1 copay at your pre-op. House of Ear you pay 1 copay at your pre-op. These are the only co-pays I remember paying. Your deductible is different.
Hope this helps.

Mindy
Title: Re: To have Titanium mesh or NOT
Post by: lrobie on June 12, 2012, 09:36:06 am
When I talked to Mary with the anesthesiologist, I asked her if she was local to LA as the area code was different.  She said they were in another state and that they do the billing/insurance paperwork for anesthesiologist in several states.  Thus, you're not calling the actually anesthesiologist.  Let me know what you find out.

It sounds like we will only have a couple of co-pays then.  You will also have your deductible.  I believe the post-op appointments are included in the surgery billing.

I'm not sure how we got off topic of Titanium Mesh.   ;)

Lisa
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 12, 2012, 11:29:37 am
When I talked to Mary with the anesthesiologist, I asked her if she was local to LA as the area code was different.  She said they were in another state and that they do the billing/insurance paperwork for anesthesiologist in several states.  Thus, you're not calling the actually anesthesiologist.  Let me know what you find out.

It sounds like we will only have a couple of co-pays then.  You will also have your deductible.  I believe the post-op appointments are included in the surgery billing.

I'm not sure how we got off topic of Titanium Mesh.   ;)

Lisa

Yes, we are way off topic.  Sorry, Mei Mei!
Title: Re: To have Titanium mesh or NOT
Post by: Jim Scott on June 12, 2012, 12:24:23 pm
Yes, we are way off topic.  Sorry, Mei Mei!


Thanks for noticing, Liza.  It saved a 'moderator reminder'.

I suggest everyone consider using the PM system to initiate or continue one-on-one exchanges.

Jim
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 13, 2012, 06:43:39 pm
Reining us back into topic which I noticed a few days ago,

Cheryl said in all 3 of her holes she has no titanium

SO, it is not necessary.   What has been central to my pain since the day I woke up from surgery on Jan 12, 2010  ,   is the titanium mesh.   I've gone through **** and two and  now maybe three additional surgeries because the the Titanium Mesh and the entrapment by it as documented by the radiologist who is now one of my best supporters, next to Dr. Ducic and Dr. Moriarity.

Please, I am begging you....don't let them put this mesh into your head to close.   I care about all of you pre ops and am warning you not to put this in your heads. 

There is no turning back from **** after the placement of that mesh.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 13, 2012, 06:46:15 pm
Reining us back into topic which I noticed a few days ago,

Cheryl said in all 3 of her holes she has no titanium

SO, it is not necessary.   What has been central to my pain since the day I woke up from surgery on Jan 12, 2010  ,   is the titanium mesh.   I've gone through **** and two and  now maybe three additional surgeries because the the Titanium Mesh and the entrapment by it as documented by the radiologist who is now one of my best supporters, next to Dr. Ducic and Dr. Moriarity.

Please, I am begging you....don't let them put this mesh into your head to close.   I care about all of you pre ops and am warning you not to put this in your heads. 

There is no turning back from **** after the placement of that mesh.
Mei Mei

Thanks for the warning, Mei Mei.  I have it on my list of questions for Dr. Slattery.  I may need to put my wishes in writing, so they don't forget.

Liz
Title: Re: To have Titanium mesh or NOT
Post by: FlyersFan68 on June 18, 2012, 09:36:15 am
I don't have titanium mesh and "likely" as a result.. no headaches. Eight years post-op. Also, get a copy of your surgical report so you have it forever and know exactly what was done.
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 24, 2012, 02:40:39 pm
I talked with Dr. Slattery on Friday evening.  I don't know whether all the docs at HEI do this, but he does use titanium mesh to close up the skull.  It allows the bone to completely regrow, so that I won't have a soft spot.  He said that the risk of nerve entrapment from the mesh comes with retro, not translab.  He also said they use special mesh plates that are molded, not cut, so they have no sharp edges to cause pain.  It sounded pretty convincing.

Has anyone with titanium mesh later had a BAHA pedestal implanted?  I hate to think what would happen if they drilled through the mesh - that would definitely cause sharp edges.  How do they make sure they avoid it?  Does it show up on MRI, so they can plan accordingly?

Liz
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 24, 2012, 04:58:02 pm
all I know is that at Cleveland Clinic, the doctor injected trough the Titanium mesh and nearly killed me.  I am still recovering from that mess   They injected 7 or 8 times through the med and then I passed out and my eyes dilated.  I was intubated and passed out.  That means I was a hair's length from death.   I still fell my mesh two year later.   I wish I had never had the mesh implanted.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 25, 2012, 11:02:48 am
all I know is that at Cleveland Clinic, the doctor injected trough the Titanium mesh and nearly killed me.  I am still recovering from that mess   They injected 7 or 8 times through the med and then I passed out and my eyes dilated.  I was intubated and passed out.  That means I was a hair's length from death.   I still fell my mesh two year later.   I wish I had never had the mesh implanted.
Mei Mei

That's scary, Mei Mei.  Did they know you had it at the time?

Liz
Title: Re: To have Titanium mesh or NOT
Post by: pjb on June 25, 2012, 11:13:28 am
I talked with Dr. Slattery on Friday evening.  I don't know whether all the docs at HEI do this, but he does use titanium mesh to close up the skull.  It allows the bone to completely regrow, so that I won't have a soft spot.  He said that the risk of nerve entrapment from the mesh comes with retro, not translab.  He also said they use special mesh plates that are molded, not cut, so they have no sharp edges to cause pain.  It sounded pretty convincing.

Has anyone with titanium mesh later had a BAHA pedestal implanted?  I hate to think what would happen if they drilled through the mesh - that would definitely cause sharp edges.  How do they make sure they avoid it?  Does it show up on MRI, so they can plan accordingly?

Liz

I have the Titanium but the screws are up from the huge incision  now to get someone to get them out and I am sure that this is not normal ??

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: leapyrtwins on June 26, 2012, 11:28:40 am
Liz -

I have titanium mesh and a BAHA implant.  My BAHA site is directly on top of my AN surgery site.

The same doc did both procedures so he knew what was inside my head and where it was located.  However, you don't have to have the same doc do both your AN surgery and your BAHA implant.  You just need to let him/her know that you had AN surgery and what approach you had (translab vs retrosigmoid vs mid fossa). 

BAHA implants aren't all that invasive.  Yes, a titanium rod is sunk into your skull, but AN surgery is much more invasive.

A BAHA site may or may not "interfere" with your AN surgery site.  If the doc thinks it will, the BAHA site can be located in a different spot on your skull.  The main thing with a BAHA implant is that the area in which it is implanted needs to have sufficient density to allow the titanium rod to calcify into your skull. 

The only issue I had with my surgery sites being on top each other involved one of the titanium screws from my AN surgery.  It ended up being very close to the surface of my scalp after my BAHA implant and 2 years after the procedure it had "popped up" enough to lead me to ask my doc to remove it (my doc told me that this might become an issue).  He removed the screw, which was extremely tiny (pics on the Forum somewhere - just search), and everything was perfectly okay.

No worries,

Jan



Title: Re: To have Titanium mesh or NOT
Post by: Jim Scott on June 26, 2012, 02:47:07 pm
I have titanium mesh and a BAHA implant.  My BAHA site is directly on top of my AN surgery site.

The same doc did both procedures so he knew what was inside my head and where it was located.  However, you don't have to have the same doc do both your AN surgery and your BAHA implant.  You just need to let him/her know that you had AN surgery and what approach you had (translab vs retrosigmoid vs mid fossa). 

BAHA implants aren't all that invasive.  Yes, a titanium rod is sunk into your skull, but AN surgery is much more invasive.

A BAHA site may or may not "interfere" with your AN surgery site.  If the doc thinks it will, the BAHA site can be located in a different spot on your skull.  The main thing with a BAHA implant is that the area in which it is implanted needs to have sufficient density to allow the titanium rod to calcify into your skull. 

The only issue I had with my surgery sites being on top each other involved one of the titanium screws from my AN surgery.  It ended up being very close to the surface of my scalp after my BAHA implant and 2 years after the procedure it had "popped up" enough to lead me to ask my doc to remove it (my doc told me that this might become an issue).  He removed the screw, which was extremely tiny (pics on the Forum somewhere - just search), and everything was perfectly okay.

Liz ~  Here's a link to the photo: http://i219.photobucket.com/albums/cc207/leapyrtwins/100_0693A.jpg (http://i219.photobucket.com/albums/cc207/leapyrtwins/100_0693A.jpg) 

Jim
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 26, 2012, 11:07:01 pm
Thanks, ya'll.

Jan, are you saying they put the BAHA implant directly through your titanium mesh?  Maybe by 9 months post-op, there is so much bone on the mesh that it really doesn't matter?

I'm assuming the bone grows on both sides of the mesh and it becomes completely integrated into the skull.  It doesn't sit on top of the skull, right under the skin, does it?

Mei Mei, did they inject something into your skull itself, or just into your scalp?  How long after your surgery were these injections?  That sounds like a horrible experience.

I really want to understand this, as my surgery is a week from today.  On the other hand, I probably can't ask Dr. Slattery to change how he does the translab procedure just for me, and I'm too committed to cancel it now.  He seems very confident that the titanium mesh is a good idea.  He mentioned that titanium is used in facial reconstruction, with very good results.

What would happen if someone wanted to have the titanium mesh removed at a later date?

Liz
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 27, 2012, 10:09:53 pm
I was having terrible headaches from the day after my surgery in 2010 Jan.   I started seeing a neurologist and he gave me Verapamil for 2 mos, Lyrica for a month and Lithium for a month with no impact on my headaches but many side effects.   He sent me to the Pain doctor and the pain doc said I was too complicated and to go to Cleveland Clinic pain center.   I did so and when the doctor came in the room he asked if I had any bone removed and I said I'm not sure, here is the op report.  He said I don't need to see that It has nothing to do with your headaches (but it did answer his question).   He then pointed to my x ray and said I see you have Titanium mesh and he said well I'm going to give you injections now.   I asked weren't we going to do this in the op. rm and he said that wasn't necessary.   Well that was why the doctor sent me to Ohio.    He had the nurse hold my hands and he injected the Kenelog with the Bipuvocaine.    He said he was done and then I said I feel dizzy,  he said to just sit there and I would be alright.   Then I said I can't breathe, and he said to lie down and I fell over.   Then I couldn't talk and they started racing the gurney the hall and that was all I remembered.   I passed out, stopped breathing and my eyes dilated.   My eye doctor said I was in the process of dying.   The next theing I  knew I was waking up with many people around me and a guy named Rafi Israel said he was an ER doc and I was in the ER and I had passed out and my eyes dilated.   They were keeping me intubated on life support and after a while they took out the tube.   Then they moved me to an ICU and observed me overnight.   Dr. Nagy Mekhail said that he didn't know I had bone removed and he injected directly into my brain and my eyes dilated and I stopped breathing so he intubated me.    Talk about having PTSD and knowing no one in Ohio.    I still think about the experience and the doctor never mentioned the episode in his letter to the primary care.   They didn't get a pre auth for the injections and they pursued insurance until they paid the $400 + for the injections and $10000+ for the ER.    It's all about money.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: LizAN on June 28, 2012, 07:58:35 pm
Good grief, Mei Mei, what a nightmare!  It makes me want to pass out, just reading about it.  I am so sorry you had such a terrible experience!

How long after your surgery did this happen at the Cleveland Clinic?

Li
Title: Re: To have Titanium mesh or NOT
Post by: leapyrtwins on June 29, 2012, 09:44:38 pm
Liz -

the place where my AN was is deep inside my head - basically my IAC (inner ear canal).  I doubt the titanium rod from my BAHA implant goes that deep; it's not that long.

Keep in mind that hundreds of people have titanium mesh in their skull after AN surgery and generally it's not a problem.  Mei Mei is definitely an exception. 

You are wise to ask questions and be informed, but don't worry so much  :)

Best,

Jan
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on June 29, 2012, 11:02:55 pm
The injections at CC happened 12 months after my surgery.

In reading your responses I keep thinking about Tod and about the person up in Canada that didn't have the mesh and they are doing fine.  I'm just thinking it is overkill.   What did they do before it was invented?   Tod's surgery was 32 hours long and they closed without the mesh.   When I was and still am having the entrapment one doctor said he would remove it, but removing it is not so simple as the brain has grown through the little squares in the mesh.   There are also adhesions growing there, too.   To cut all that away is a tricky surgery and pretty risky.   I just feel like less is always better.
Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: Jim Scott on June 30, 2012, 01:25:42 pm
Liz ~

I'm not sure how helpful my experience is because I underwent the 'retro' surgical procedure and don't have a BAHA.  But, for what it's worth, I have the titanium mesh and I've never experienced any problems because of it.  None. It's use is fairly common with AN surgery and I doubt it would still be used if it posed a serious statistical risk to patients.  Doctors could be sued for willful negligence if they were using the titanium mesh and it was known to cause serious problems for patients. 

Unfortunately, as with most medical issues, one size does not fit all and for the unfortunate few, such as our friend, Mei Mei, the statistics don't mean much when you're the person who pulls the short straw, as it were, and have to deal with pain, suffering and numerous medical procedures in an attempt to rectify a situation (the titanium mesh) that you had no control over.

I would suggest that what it comes down to is taking a small but very real risk that the use of the titanium mesh will pose problems for you, post-op.  I believe that the skill and knowledge of the doctor performing the surgery is a major factor in securing a good outcome to AN surgery, with few or no complications.  Because many AN surgical patients have had the BAHA implant over titanium mesh with no real problems (e.g. Jan B.), I believe the risk is relatively small.  In addition, your HEI doctor seems to take very reasonable precautions with the mesh so on balance, I don't see any reason to fear it. 

Because AN surgery is invasive and complicated and thus, daunting for the patient, we can drive ourselves crazy playing 'what if?' Since we cannot know the future, we simply have to take some risk while doing whatever we can to minimize the chances of post-op problems.  Being informed is critical but using information that (inevitably) suggests possible risks, albeit small risks, can be counter productive and if we added up all the 'what ifs', few AN patients would ever agree to undergo surgery.  Of course, then we have the risks that come with radiation, so there simply is no panacea.  We do what we can to keep the risk of potential post-op problems small and much of that is linked to choosing a doctor/team with extensive AN surgical and/or radiation experience, as you have with Dr. Slattery at the famed HEI.  I know that you trust the HEI doctors and I'm confident that your trust will be rewarded with a good surgical outcome. 

Jim          
Title: Re: To have Titanium mesh or NOT
Post by: nancyann on June 30, 2012, 02:50:16 pm
what Jim said - I'm over 6 years post op & the titanium mesh has never caused a problem.
Title: Re: To have Titanium mesh or NOT
Post by: texsooner on June 30, 2012, 04:22:58 pm
I'll chime is as another one who had retrosigmoid surgery, with the titanium mesh. I'm almost 4 years post-op with never any issue with the mesh. I agree with Jim's analysis that the benefits using titanium mesh must outweight the potential problems, or it wouldn't be so widely used. I know this is no comfort for someone like Mei Mei who has had a bad experience, but I don't believe that is common. I would trust your HEI surgeon. 

Patrick
Title: Re: To have Titanium mesh or NOT
Post by: pjb on July 01, 2012, 09:15:19 am
I have had problems with the titanium screws but I blame it on the surgeons not the titanium itself especially with many great outcomes with others definitely depends on the team that do it !!

Best Wishes,
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on July 08, 2012, 08:42:01 pm
I think why I am different than Jan and Jim is that I also have Ehlers Danlos Syndrome which is a genetic disorder with chronic pain and all sorts of symptoms.    I'm sure that this is why I have not recovered from the Retrosigmoid as others have, but there are several that are like me and I wonder if they too have Ehlers Danlos Syndrome.   You can go to a geneticist and be diagnosed.   The most famous geneticist for EDS is Claire Francomano in Baltimore.   I think if I were a pre op now.  I would shop around until I found a doctor to agree to not put the mesh in.   The woman in Canada didn't have it and she did fine.   I feel this mesh pressing on the dura every second of the day and now wish that I had Watched and Waited till I had found out what I needed to know to proceed.   I rushed into it to get the tumor out and for something that the doctor said to me that I chose him instead of House.   He said that my  tumor was in a position to put me at risk for stroke.   Since then I have never heard this mentioned on the posts.


Mei Mei
Title: Re: To have Titanium mesh or NOT
Post by: Mei Mei on July 09, 2012, 09:28:53 am
There have been many people that have contacted me about their headaches and occipital neuralgia with the nerve entrapment.    I've sent them to Dr. Ducic and Dr. Moriarity for the surgery at Georgetown.     I'm really not an exception.    Talk with Janet, Lizard, Cin605  and the others are not member so you can't contact them on the Forum.
Let us know how your surgery turned out.
Mei Mei