Author Topic: Looking for NE contacts  (Read 8238 times)

Pooter

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Re: Looking for NE contacts
« Reply #30 on: January 20, 2009, 02:17:11 pm »
This is blatantly stolen from one of Kate's posts:

"From the House Ear Clinic Website:
House Ear Clinic CONSULTATIONS

If you, a family member, or someone you know has been diagnosed with an acoustic neuroma, you may consult with a doctor from the House Ear Clinic team. We will be happy to review the MRI scans and audiogram and speak with you by telephone (we must have a copy of the actual MRI film, reports are not sufficient by themselves).

Send the MRI scans by express delivery (be sure that you are able to track the package) to:

House Ear Clinic
Attn: Acoustic Neuroma Website Consultations
2100 W. Third Street, 1st Floor
Los Angeles, CA 90057

You can expect to hear from a House Ear Clinic physician within 24 hours of our receipt of your information. You may also call or fax a House Ear Clinic physician at:

Telephone: (213) 483-9930
FAX: (213) 484-5900"
Diagnosed 4/10/08 - 3cm Right AN
12hr retrosig 5/8/08 w/Drs Vrabec and Trask in Houston, Tx
Some facial paralysis post-op but most movement is back, some tinitus.  SSD on right.
Story documented here:  http://briansbrainbooger.blogspot.com/

"I must be having fun all wrong!"  - Roger Creager

Seal

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Re: Looking for NE contacts
« Reply #31 on: January 20, 2009, 04:28:24 pm »
Very cool!    Thanks Brian.
Diagnosed 1/14/09 - 2.4cm AN right side --- about 70% cycstic
Retrosigmoid wiih McKenna & Barker - total removal successful on April 13th. 
Issues: balance, facial & mouth numbness, hearing loss right side
Results:   numbness gone, balance is good, SSD right side. Great results.

mk

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Re: Looking for NE contacts
« Reply #32 on: January 20, 2009, 06:54:19 pm »

My one question this evening is about facial nerves.     I have control over my muscles to smile, etc, but I have no surface feeling on the right side of my face, nor in my mouth or throat.     Is this a seperate nerve from the auditory nerve or all part of the same one?    I even have no skin feeling all the way back into my  scalp on the back of my head!!     My most frustrating problem is that i don't feel where my tongue is , and I've already bitten it badly several times this week just eating.       All my symptoms seem to be getting worse by the day...............

Steve

I missed this thread, but I think I can answer your questions, since I have the same symptoms exacty. The cranial nerves usually involved when you have an AN are the 5th nerve, or trigeminal, which controls sensation, the 7th which is the facial nerve, responsible for movement, and the 8th which is the vestibulocochlear (aka acoustic). ANs typically grow on the vestibular (balance) branch of the 8th nerve. The facial nerve runs very close to the 8th nerve, and is almost always involved. However, it can be stretched quite a bit without causing any symptoms, that's why facial weakness prior to treatment is usually rare. The 5th is what's causing your symptoms - numbness, metallic taste and I bet you are experiencing dry eye as well. The trigeminal has three branches, some or all may be affected. It is usually affected when the AN has grown big enough in the CPA, so that it impinges on its root entry to the brain stem (I copied this from my radiologist report  8)).

My symptoms progressed fairly quickly from metallic taste to numbness around the mouth and then extended all the way to the scalp as you described - all this in a couple of month. From what I understand once the AN starts touching the trigeminal nerve, the symptoms get worse fairly quickly.

Hope this helps,
Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

Seal

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Re: Looking for NE contacts
« Reply #33 on: January 21, 2009, 10:15:03 am »
Hi Marianna,

Thanks for the info.   Unfortunately, my symptoms have progressed from almost nothing to where I'm at now in a matter of weeks.    You hit the nail on the head so to speak with all my current symptoms including the now increasingly dry eye problem.     I'd be curious to know why you selected GK as the treatment instead of going for immediate removal and hopefully faster relief of at least part of the symptoms?   

Steve
Diagnosed 1/14/09 - 2.4cm AN right side --- about 70% cycstic
Retrosigmoid wiih McKenna & Barker - total removal successful on April 13th. 
Issues: balance, facial & mouth numbness, hearing loss right side
Results:   numbness gone, balance is good, SSD right side. Great results.

mk

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Re: Looking for NE contacts
« Reply #34 on: January 21, 2009, 11:22:00 am »
Steve,

there were several reasons why I chose GK over surgery, I summarize them below:

1. Having 2 young kids, a very busy job with lots responsibilities and not much help around from extended family,  it would be very difficult to cope with a long recovery time, and the various possible after effects that I might possibly face.
2. Lack of doctors specializing in ANs in my town, meaning that I would need to travel further to seek surgery and treatment for any potential post-op complications. Couldn't figure how all this could be juggled with family responsibilities.
3. (and more relevant to your question). I'd rather live forever with my facial numbess, than having to deal with paralysis, not being able to close my eye, vertigo, headaches etc. And there is no guarantee that the numbess would resolve after surgery either, I might say that there is more of a chance that things can become even worse if the nerve is damaged during surgery. In the case of the trigeminal nerve, trigeminal neuralgia can cause really debilitating pain if the nerve gets aggrevated.

Honestly, I don't find the numbess being a problem at all - I am actually very grateful that this is my only problem and it certainly does not cause any "quality of life" issues. The dry eye can be dealt with easily with eye drops three times a day. The metallic taste (which is actually getting better) is triggered by foods that are very sweet or salty so I avoid them (good habit!). And I try  to chew slowly, so that I don't bite my tongue (again, good for the stomach).
As for the hearing, I know that it is a big deal for many people. I have pretty much accepted the fact that having an AN will probably lead to hearing loss eventually. I only had minor hearing loss (about 10-15 db, with 100% word recognition), and it is holding steady after GK. I will consider my self extremely lucky if I retain some hearing, but this was not my main preoccupation.

Your AN is very similar size as mine (mine is larger), so I understand how you are going through the same anxieties regarding size/treatment choice etc. Feel free to PM me if I can be of any help.

All the best,
Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

Seal

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Re: Looking for NE contacts
« Reply #35 on: January 21, 2009, 04:22:37 pm »
Marianna,

Thanks for the detailed reply.    Since we are similar in terms of size and issues, I was curious as to the thought process behind the decision.     I just met with the first doctor today.     BTW, Jim ---- Dr. Goodrich says hi !   Anyways, I guess I do not have a really large one at 2.2mm , but the bad news is the placement.   Where alot of these tumors tend to head towards the spine, mine instead is heading upwards and pushing against the brain stem.    Evidently this is why my issues have gone from zero before Christmas to complete deafness in the right ear, lack of balance, and complete loss of feeling in the right side of my face, mouth, and throat.     According the Dr. Goodrich, I would normally be a perfect candidate for GK like you.     However, the placement of the tumor is causing a rapid deterioration of all the nerves in that area with more pressure being put on the brain stem.   

So it may end up being a similar case to Jim Scotts treatment.     They may go in for a removal of the bulk mass of the multi-lobe tumor to give immmediate relief of pressure to the brain stem.   Then there would be follow up radiation treatment to kill the rest of the tumor and keep it from growing back.     Whatever the final decision is, the clear thing is that we have to act quickly to stop the pressure from growth due to the unlucky placement of my AN.         The other interesting thing was that the doctor mentioned that I've probably had this for 10-15 years which is how long it takes for it to grow until the symptoms become evident. 

Of course the hearing loss is a done deal.   He did hold out some hope for me however to see a return of feeling to the face once the tumor is debulked and the pressure is taken off those other nerves.     One meeting down; many more to come I'm sure..............

Regards,
Steve
Diagnosed 1/14/09 - 2.4cm AN right side --- about 70% cycstic
Retrosigmoid wiih McKenna & Barker - total removal successful on April 13th. 
Issues: balance, facial & mouth numbness, hearing loss right side
Results:   numbness gone, balance is good, SSD right side. Great results.

mk

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Re: Looking for NE contacts
« Reply #36 on: January 21, 2009, 07:39:03 pm »
Steve,

location, location, location is everything and it is a determining factor when chosing treatment. This is why there is no absolute cutoff with radiation and every case is judged individually. If brainstem compression is such a serious issue then the doctors will definately want to decompress it. In my case I was told that the brainstem compression was not substantial. Rather my AN was growing backwards and rather than the brain stem it was compressing the 4th ventricle (serious compression may cause hydrocephalus because it obstructs the flow of CSF). But anyway, I guess the absence of severe brain stem compression is what made treatment with GK possible.
The key here is getting as many opinions as possible, so that you can make an informed decision. From what Jim has said many times, you are in good hands with Dr. Goodrich.

Marianna
GK on April 23rd 2008 for 2.9 cm AN at Toronto Western Hospital. Subsequent MRIs showed darkening initially, then growth. Retrosigmoid surgery on April 26th, 2011 with Drs. Akagami and Westerberg at Vancouver General Hospital. Graduallly lost hearing after GK and now SSD but no other issues.

leapyrtwins

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Re: Looking for NE contacts
« Reply #37 on: January 21, 2009, 11:58:26 pm »
The other interesting thing was that the doctor mentioned that I've probably had this for 10-15 years which is how long it takes for it to grow until the symptoms become evident. 


Seal -

although you sound surprised by this, ANs are typically very slow growing.  I don't know if I recommended it to you before or not, but you should contact the ANA and ask for their literature.  It explains a lot about everything "AN".

As for the hearing loss, don't let it worry you too much.  As Brian (Pooter) mentioned, there are options for SSD - if you find you just don't adjust well to it.  I chose a BAHA implant and am very happy with the results.  Others have chosen the TransEar and they are happy with their choice also. 

BTW I know you are still researching doctors, but IMO Dr. Goodrich would be an excellent choice.  He gets my vote.

Just my two cents worth,

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways

sgerrard

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Re: Looking for NE contacts
« Reply #38 on: January 22, 2009, 12:06:58 am »
BTW I know you are still researching doctors, but IMO Dr. Goodrich would be an excellent choice.  He gets my vote.

I have to agree with that; he seems to be very sharp.
 
And if Jim is any indication, being treated by Dr. Goodrich apparently has the added benefit of enriching your vocabulary.  :D

Steve
8 mm left AN June 2007,  CK at Stanford Sept 2007.
Hearing lasted a while, but left side is deaf now.
Right side is weak too. Life is quiet.

Seal

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Re: Looking for NE contacts
« Reply #39 on: January 23, 2009, 09:15:09 am »
Well, I have more opinions weighing in on my options as the MRI CD copies are finding their way into different hands!   Its clear now that Gamma Knife is not an option for me.     I already have complete hearing loss, and its not coming back.   So the clear choice will be for removal.     The biggest concern left now is how to accomplish removal without impacting or minimizing impact to the facial nerve that it is pushing against.      At the rate of growth lately, it is obvious that its a "sooner than later" situation.   

Has anyone here been have any feedback on the ENT Medical Surgical Group at Yale headed by Dr. Kveton?   

Steve
Diagnosed 1/14/09 - 2.4cm AN right side --- about 70% cycstic
Retrosigmoid wiih McKenna & Barker - total removal successful on April 13th. 
Issues: balance, facial & mouth numbness, hearing loss right side
Results:   numbness gone, balance is good, SSD right side. Great results.

Pooter

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Re: Looking for NE contacts
« Reply #40 on: January 23, 2009, 10:14:55 am »
Steve,

I haven't heard of those doctors specifically, although you can use the "Search" function of this website and put in "Kveton" and see if anything pops up.

I would agree that if you're seeing new symptoms and the ones you have seem to be getting worse that sooner rather than later is definitely called for.  I realize that the tumor is near the facial nerve, therefore explore the option with you doctor to "debulk" the tumor (leaving some attached to the facial nerve) and use radiation (GK?) to kill that later.  Unfortunately, they won't know how "sticky" the tumor is until they get there during surgery.  It's very possible that it won't be "sticky" and it will just peel away from that nerve without any further damage.  I certainly hope so, but talk to doctors about the option of "debulking" the tumor in favor of further damage to the facial nerve. 

Most reputable doctors will monitor that facial nerve during surgery so they know if they're ticking it off or not.  Facial nerve monitoring appears to be the norm for this type of surgery, but make very sure that you're doctor (whoever you select) does monitor that nerve during surgery.

Kindest regards,

Brian
Diagnosed 4/10/08 - 3cm Right AN
12hr retrosig 5/8/08 w/Drs Vrabec and Trask in Houston, Tx
Some facial paralysis post-op but most movement is back, some tinitus.  SSD on right.
Story documented here:  http://briansbrainbooger.blogspot.com/

"I must be having fun all wrong!"  - Roger Creager

Jim Scott

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Re: Looking for NE contacts
« Reply #41 on: January 23, 2009, 03:43:09 pm »
Jim ---- Dr. Goodrich says hi !
   
Steve

I'm glad you were able to consult with Dr. Goodrich but sorry to learn that your AN is growing toward your brainstem and causing you the myriad problems you've encountered recently.  Dr. Goodrich is correct when he says that - normally -  a 2.2 cm AN would be a prime candidate for radiation.  One other person I referred to Dr. Goodrich had a  tumor approximately the size of yours.  After a consult, Doctor Goodrich ruled out surgery for him, secured an immediate appointment with the radiation oncologist for the man and even escorted the fellow to the other doctor's office (it was in the same building).  Dr. Goodrich is clearly not 'possessive' of patients and definitely not 'cut-happy' as, unfortunately, some surgeons are.

For better or worse, you do seem to be in a situation similar to mine when I presented to Dr. Goodrich, with the notable exception that my AN was 4.5 cm.  During my surgery, when the doctor opened up my skull, he later told me that CSF literally 'gushed' out due to the fact that the AN was taking up so much space in that tiny area and compressing it.  He was surprised my symptoms were not worse than they were.  Dr. Goodrich also mentioned that the AN had likely been growing - slowly - for over a decade. 

If you end up going with the debulking + radiation approach, it should work out well.  The debulking almost immediately relieved all of my symptoms (loss of taste, rapid, unwanted weight loss, slight one-sided facial numbness, disequilibrium, severe fatigue).  Although the follow-up FSR (3 months later) was tedious (26 days @ 20 minutes per day strapped to a metal 'bed' with my head bolted onto a rigid,'mask', making it unmovable, while the Linux 'zapped' me in short bursts) I suffered no ill effects, save boredom.  As my signature shows, both the surgery and radiation were successful.  My symptoms never returned, I have full function of my face, eye and tongue, I regained just about all of my balance function and suffered no complications from either the surgery or the FSR.  Like you, my hearing was a 'lost cause', based on the fact that the tumor had effectively compromised the nerve to the point that it became non-functional and cannot be reanimated.  I cope pretty well with the SSD aspect and, fortunately, the hearing on my  functioning ear is excellent.  One learns to adapt.  However, there are Bone Anchored Hearing Aids ('BAHA') that can alleviate some of the hearing loss, should you opt for one in the future., as many do, with much satisfaction, I might add. Jan ('leapyrtwins') is an enthusiastic BAHA-wearer and could give you lots of information on it's efficacy, should you be curious at some point.

I'll be interested to see what other doctors have to recommend as you go through the consultations.  I certainly hope you end up with a successful outcome, whatever physician you chose.  Admittedly, I'm a bit biased toward Dr. Goodrich, based on my high regard for his surgical skill and overall knowledge of acoustic neuromas gained from his decades of experience operating on them and, equally important, his caring, professional attitude and respect for his patient's concerns.  Of course, I have to add the caveat that my good outcome cannot guarantee yours - or anyone's - but I'm confident that, should you choose Dr. Goodrich and his team, you'll certainly be in good hands.  I wish you well as you continue your journey toward a final decision.  :)

Jim
« Last Edit: January 23, 2009, 05:02:18 pm by Jim Scott »
4.5 cm AN diagnosed 5/06.  Retrosigmoid surgery 6/06.  Follow-up FSR completed 10/06.  Tumor shrinkage & necrosis noted on last MRI.  Life is good. 

Life is not the way it's supposed to be. It's the way it is.  The way we cope with it is what makes the difference.

Seal

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Re: Looking for NE contacts
« Reply #42 on: January 23, 2009, 04:20:45 pm »
Hi Jim,

Thanks as always for your detailed responses.  I asked Dr. Goodrich if there was any extra charge for the vocabulary enhancement procedure that Leapyrtwins mentioned earlier.     He just said it comes at no charge!! 

Anyways, I've already received feedback from my cousin at Geisinger.   His team came to the same conclusion as well that radiation is NOT an option, and that due to my "youthful" age, the only real option is to remove it and get on with life.   He has refered me now to Dr. Kveton.    So we will get yet another opinion, and I'll shift through those comments and try to get closer to making a decision.       I have an extra CD, and I'm thinking about sending it out to House just to see what they say.    However, I'm not inclined to fly to L.A. for treatment when I believe there is sufficiently excellent care right here in New England.      I'm sure another opinion would not hurt either.       This seems to be going so much slower than I would like. 

I am also getting more concerned about the post-op recovery.    I am president and owner of a small mfg company with about 15 employees.    I can't imagine this coming at a worse time, but that's how life is I guess.      Hopefully, I will not be too out of things for too long.     I'd like the impact to the business to be a small as possible, but I've read a few posts about some individuals having serious problems afterwards and not returning to work for weeks or even months.    That is giving me more concern quite frankly than the surgery itself.     

Thanks again, and have a great weekend.

Best,
Steve
Diagnosed 1/14/09 - 2.4cm AN right side --- about 70% cycstic
Retrosigmoid wiih McKenna & Barker - total removal successful on April 13th. 
Issues: balance, facial & mouth numbness, hearing loss right side
Results:   numbness gone, balance is good, SSD right side. Great results.

Rivergirl

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Re: Looking for NE contacts
« Reply #43 on: January 24, 2009, 09:36:56 am »
Seal, I have read your posts and must say I am a bit jealous, watch and wait is unnerving, I think if the Dr. said lets go and take it out in the first place, I would be done and getting on with my life.  Instead I deal with the symptoms everyday and just wait....
Anyway if you are the owner/president of a company than you can come and go as you feel up to it, so it might not be that bad, alot of people do quite well after, getting tired seems to be the big thing. Your journey is an interesting one, keep us posted and best of luck for a complete recovery.
Diagnosed 6/2008
Right AN 2cmx8x9
Sub-Occipital at Mass General with Martusa and McKenna on 5/31/11
Right SSD, very little taste
I think I will make it!

leapyrtwins

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Re: Looking for NE contacts
« Reply #44 on: January 25, 2009, 04:08:13 pm »
I asked Dr. Goodrich if there was any extra charge for the vocabulary enhancement procedure that Leapyrtwins mentioned earlier.     He just said it comes at no charge!! 


Hey wait a minute  ???  I didn't say that - Steve Gerrard did - so I can't take credit - I can only wish I'd said it.  It was a very good line  :D  And just for the record, I'm not picking on Jim here, I truly enjoy his vocabulary and I'm proud to say that I've learned several new words - and their definitions - from him.  Many thanks, Jim.

Now, back to the topic  ;D

Seal -

don't let the time off of work concern you too much.  Most docs say 6 weeks recovery time, but everyone is different and everyone's job is different.  Depending on how you feel and what you do at your job, you may be able to work part-time or work from home long before you are fully recovered.  And although you are president and owner, I'm betting you have at least one very capable employee who can handle things for a short time in your absence. 

I'm an accountant - obviously a desk job - and I returned to work part time @ 2 1/2 weeks and full time @ 4.  I don't have a physically taxing job, so that probably helped.  I also had the luxury of having a family member driving me to work so I didn't have to deal with that.  My biggest issue was fatigue - which lasted long past the 6 weeks.  IMO returning to work within a reasonable time frame is more the norm than the exception. 

Jan
Retrosig 5/31/07 Drs. Battista & Kazan (Hinsdale, Illinois)
Left AN 3.0 cm (1.5 cm @ diagnosis 6 wks prior) SSD. BAHA implant 3/4/08 (Dr. Battista) Divino 6/4/08  BP100 4/2010 BAHA 5 8/2015

I don't actually "make" trouble..just kind of attract it, fine tune it, and apply it in new and exciting ways