MVD Diary - Alex Handyside
After 14 years of right-sided HFS, and 7 years of increasingly ineffective Botox injections, I was referred to a neurosurgeon in July ’03 who was willing to conduct an MVD (right). Because there was no monitoring device in Nova Scotia (which apparently reduces the risk of permanent hearing loss from 8% to 2%) he suggested I go to Toronto, Ontario for the op. However, the Ontario surgeon ignored all attempts to contact him. By Jan ’04 I asked my Halifax surgeon to conduct the op, despite the increased risk. The op took place March 9, 2004 and lasted 5.5hrs (instead of 2.5-3.0hrs). It took longer because the artery that my surgeon thought was causing the problem was not. He found the rogue artery, under the cerebellum and put in two Teflon sponges. The cerebellum had to be lifted a little to reach the artery, and that apparently is what caused many of the post-op problems. I awoke from the op in the recovery room feeling pretty bad. However, my hearing was OK (not perfect) and the spasm had gone. Rather than describe the recovery chronologically, I’ll itemize everything. At the end is the description of the Bell’s Palsy that very surprisingly developed on day 9.
Tongue:
The worst part of the entire op/recovery was my tongue – it was incredibly swollen. It was so big I couldn’t swallow – I was gagging – and I wasn’t permitted water for about 30 minutes after waking. About three hours after waking, I was guzzling lots of iced water (through a straw) and felt a little better. By day 3, my tongue developed massive blisters on the left side – it was quite painful. I was given drugs for the swelling, which all but disappeared by day 11. None of the doctors knew what had caused the swelling. I asked to speak to the Anesthesiologist on Day 2 and he explained that there had been a sponge block at the back of my mouth. When he tried to remove it using forceps, he guessed that he grabbed my tongue with the forceps by mistake instead of the sponge. On day 9 I lost partial movement of my tongue (see the section on palsy, below). I couldn’t stick my tongue out straight (which apparently is one of the signs of a stroke). It only lasted a day (and it wasn’t a stroke). By day 15 my tongue was completely back to normal, but the anesthesiologist was no longer on my Christmas card list.Vision:
I knew the operation had been a success the moment I awoke: the flickering eyelid had gone! I had blurred vision on the right for a day. I could read comfortably for extended periods from day 2 (I read a novel for the first time in years). Some slight blurring returned on day 9 when the palsy meant that my right eye wouldn’t close completely and the eye watered incessantly. But that lasted less than 6 weeks. I am now a voracious reader – because I can!Hearing:
I had a peculiar ‘fullness’ in my right ear, which took about 10 days to go from 50% to 95%. The last 5% did not return until after day 40 or so (difficult to tell exactly when). I have had tinnitus for years – and it has not changed.Drumming:
If you’ve had HFS, you’ll know all about the constant drumming you can hear when you’re lying in bed in the quiet wee hours of the morn. If you’ve never had HFS, try clenching your jaw as tight as you can. The noise you can hear is the facial muscles contracting. Now release & clench, release & clench those muscles as fast as you can. That’s what it’s like inside the head of a HFS sufferer at night: the drumbeat happens about 5 times per second – constantly. At night it’s enough to keep you awake. This is a round about way of saying the drumming stopped on day 1. If it happens to start up again, I know it’s just stress: I allow my jaw to relax and the drumming stops within 10 seconds - always.Numbness:
The entire right side of the back of my head and my right ear were numb. The feeling around the ear came back around day 7. The back of my head very slowly came back by day 25. At the 6-month mark, there is still some minor numbness around the wound. My face went partially numb on day 9 (see palsy, below) – lasted about 10 weeks.Pain:
I awoke with a severe pain in my upper left arm (they said I’d been lying on it for 5.5hrs), which took a week to disappear. There was a pain in a band across the back of my head, which took about 5 days to go. On day 9 I developed a pulsating, occasional pain behind my right ear lobe (apparently due to the cerebellum being moved): that’s where the facial nerve goes through the bone of the upper jaw to reach the face. That pain lasted about 5 days. No pain after about day 15.Bruising/swelling:
Besides the tongue (above) I had some serious swelling on my left temple (from in front of my ear-lobe in a straight line about 5-6” long and about 1” wide. The head frame apparently caused this. There were two clamps holding my head steady and each of them left a very raised 1” diameter swelling on my scalp. The above swelling disappeared by about day 11. My neck was sore for about 4 days. My jowls (chin) were swollen for about a week - not sure why.Hair loss:
Due to the clamp against my skull I developed a quarter-sized scab above and slightly in front of my left ear (the op was on my right side). It was quite raised and when the scab eventually fell off, it took a quarter-sized lump of scalp with it! I had a bright pink bald spot! After six months, the hair that has grown back is whiter than the surrounding gray hair, and of a slightly different texture, but at least it grew back.Head/Neck Movement:
I was surprised how much movement I had in my neck. Up/down movement was never restricted. Left/right movement went from about 150° on day 1, to about 170° by day 7 (when I started driving again) to about 180° by day 11.By day 30 I could spin it around like an owl.Headaches:
The headaches were tolerable until they disappeared altogether by day 7. (See the section on drugs, below). There was some soreness around the wound, which prevented me from sleeping on that side of my head for about 2 weeks.Food:
I was on liquids for two days, because of the tongue swelling, then on mechanically chopped food for two days. By day 5 I was eating normally. However, the palsy made it difficult to drink, so I used a straw in public from day 9 until the palsy went. At the 6-month mark, I still occasionally dribble out the right side of my mouth when I take a big gulp of liquid, and toothpaste always dribbles out that side when I brush my teeth.Drugs:
I had morphine on day 1 & 2 for pain relief. I had the steroid Demerol on day 1 & 2 to relieve inflammation, and again on day 9. I was prescribed 5 days of the antibiotic Zithromax by the Anesthesiologist for my tongue (which badly blistered). I took ibuprofen (Advil) from day 3 (four-hourly) to day 6 (eight-hourly) to day 9 (twelve-hourly). From day 9-12 I took the occasional acetaminophen (Tylenol), and by day 13 I was drug-free.Day Nine Palsy Attack:
After some moderate recovery, on day 9 I suddenly developed numbness on the right side of my face, slight double-vision and my tongue wouldn’t stick out straight. I was advised to go into Emergency because I was showing some stroke symptoms. In Emergency I was scheduled for a CAT scan and a MRI. They were fairly sure it wasn’t a stroke because I had some feeling in my face, I reacted positively to having my cornea touched by a tissue, and there was no loss of motor response elsewhere on my body. I was told that I had symptoms of nerves CnV to CnXII being affected, most likely due to some stretching of those nerves during the surgery (when the cerebellum and brain stem were moved slightly to reach the offending artery). Bell’s Palsy is caused by pressure on the facial nerve, probably due to inflammation near the wound. I was prescribed steroids to reduce the inflammation. I was advised it would last between two and 12 weeks, with 10 weeks being the norm. The MRI & CAT scan confirmed it definitely wasn’t a stroke and showed that there was indeed some minor surgery-related swelling, but no hematoma and nothing else. It was Day 9 and the headaches and the pain behind the ear had all but gone, but I couldn’t pout, blow out my cheeks, smile, wink, furrow my brow, whistle or spit. Drinking was difficult without a straw. I was discharged on day 10. The neurosurgeon could satisfactorily explain all the symptoms, except why the palsy happened when it did (day 9). Here I am at the 6-month mark and the palsy has all but disappeared. I still can’t whistle or pout, but the smile is almost even now. So, there we have it. It’s 6 months since the op and I’m glad I had it. I could have done without the Day Nine Palsy Attack, but even though I still can’t whistle or pout, and even though I cursed the anesthesiologist daily for 5 weeks, I deem the op a complete success - thanks to Dr. Rob Brownstone and his team at the QE II Health Sciences Centre in Halifax NS. If anyone has any questions, please feel free to contact me at handyside@nitrotek.com.