MVD Diary - John MacBain

Surgery performed by:   Dr. Troy Payner
Surgical Location:          St. Vincent Hospital, Indianapolis, IN (USA)
Surgery Date:                 October 6, 2005

Diary prepared by:         John MacBain
Date diary finalized:       October 23, 2005

Summer 2005:

 During this time I was exploring the web for information concerning HFS and MVD and found this wonderful HFSA website. I have had HFS since 1992, but worse since a Bell’s Palsy in 2002. While it has been bad, it probably has not paralleled that described by others on this site. I would have seizures that would close my right eye, or have it squinting. Meanwhile, the mouth would pull up looking as if I had a stroke. The right central ligament in the front of the neck was also involved at the end.

I first sought treatment in 2002. My first neurologist tried every drug invented and I left after a year. Suggested Botox® but did not mention surgery. My next neurologist stated the only cases where he saw drugs work were where the patient was nearly asleep with the drugs. He sent me to a partner for Botox®. Once again, no mention of surgery. When I inquired last year of the Botox® doctor about surgery, she told me the very limited amount she knew about it.

It was during early 2005 that I started scouting out where I would have my surgery. I found my insurance could take me to either center in Pittsburgh, but I decided to search further. I obtained references from my family doctor (through a neurologist classmate of his) and my neurologist. I also wrote an acquaintance in Dayton, Ohio, who is a retired neurosurgeon, and asked him who he would recommend in a multi-state region including Pennsylvania. All three independently returned the name of Dr. Troy Payner in Indianapolis IN (USA). Dr. Payner had all his medical training at the University of Cincinnati, and seems to have associations with the Mayfield Clinic.

Early September 2005:

 I met with Dr. Payner and was impressed with his demeanor, confidence, and humility. He has done hundreds of MVD surgeries, being split between Trigeminal Neuralgia and HFS as per the population incidence. Many patients have come from great distances for this surgery with him. I already had a MRI from 2002 which I provided to him. At this point I made the decision to stay local and have the surgery.

Late September 2005:

 On two separate days I had preliminary tests. The first was an Audiogram by a Dr. Hauser, and fortunately, my hearing was fine in both ears. I also had preliminary tests at St. Vincent Hospital including endless blood work, and a EKG. The staff indicated Dr. Payner requires far more in pre-testing than most surgeons and has a reputation for completeness, details, and caring.

Thursday, October 6, 2005 - “MVD Day”:

 I arrived at St. Vincent’s at 9:00 AM for an 11:00 AM MVD. The preparation included the attachment of an IV which was the most traumatic event in the visit (other than another IV coming later). The extensive multicolored bruise covering half my forearm will last beyond any pain from the operation! I also had a preliminary baseline BAER reading.

At about 10:15 AM someone announced the Doctor was ready and the room was ready, so off we went long before my pastor had arrived. Once on the operating table, they put me to sleep before positioning me and before adding the arterial IV (that spot is still painful!). They also shaved my head after I was out, but this was only a very narrow strip right along the incision line (1/2” wide at most).

The first step in the operation is one most of you did not have. Dr. Payner takes a spinal tap to “relax the brain” before entering the skull. While I do not fully understand the implications of this, he certainly is doing something quite right as you will see later.

Once the surgery started, the process was evidently the typical pattern you see on the web. I was monitored by BAER and EMG with a separate person for each system. Dr. Payner indicated my case was one of the messiest he had seen. I had an artery coming between the VII and VIII cranial nerves which then doubled back on itself and went through a second time, both very near the brain stem. There was also another artery on the other side of the VII nerve. He padded all with sponges, and the person who monitored the EMG indicated that when he lifted the last artery, the spasms ceased. The skull was closed with the piece of bone that had been removed, with it floating between the dura mater on the inside and muscle and scalp on the outside.

The operation ended in 1.5 hours after the first incision. I do not remember the recovery room at all and I spent the evening and most of the next day in the ICU. The routine every 2 hours was questions and certain physical tests (hands out with palms up, stick out my tongue, shrug my shoulders, squeeze the nurse’s fingers, etc.) and observing my pupils react to a flashlight. I remember talking to Dr. Payner once, but it is very cloudy.

The one thing that I clearly confirmed that evening was that I was having NO SPASMS.

Friday, October 7, 2005 - Day 1 Post-Op:

 I am going to be quite detailed about all issues from here on out, please don't take this as a negative or a discouraging attitude. I simply want to convey everything, major and minor, so that you can know what to expect. As you will see, between Dr. Payner’s skill and many prayers, I faired extremely well!

The very early morning (about 3:00 AM) was not pleasant, as I had two very short bouts of nausea which passed quickly. I did not have the bad headache many have, just a dull ache in the area of the incision. I never did take any pain medication beyond an occasional Tylenol.

I was still somewhat groggy from the operation, so things are cloudy once again before about 9:00 AM. I slept most of the time they were not examining me with the questions, flashlight in the pupils, movement tests, etc. I had no appetite and when I raised up in bed to move to a chair, I was very dizzy. Fortunately, this passed within 6 hours. I was shaky in the arms, hands, legs, etc. Also, my blood pressure went sky high and they found I was low on sodium (they thought there might be a relationship?). They gave me sodium via IV, but it did not seem to impact the shakiness.

At this point I did note that I had hearing in my right ear, although muffled and distorted and hypersensitive (sudden sounds became cannon shots). This would distort also whenever I spoke even softly, very unnerving. I also had the sense that I was missing frequency ranges in the left (non HFS) ear, which had tested at 0 db loss up to 8kHz two weeks prior. But, this could be the brain compensating between the two unbalanced ear signals(?).

I also had a mild palsy on the right side of my face. The corner of the mouth would not turn up as it had (slightly at best) before the surgery, so it was probably a surgical effect. The right eyelid did not fully close during a normal blink, the eyeball rotated outward rather than upward just as when I had had real and extensive Bell’s Palsy in 2002 (eyeball rotation visible to others, but not to me)! This resulted in a sore eyeball surface and lots of eye drops, even though tearing seemed excessive already. (Basically, this is a very mild version of the full Bell’s Palsy I suffered back then).

In the afternoon, they moved me to a regular room which was well received as the testing only came every 4 hours. I also was more alert and had my wife describe the incision. It was a railroad track of staples, with about a perfect incision line. The hair had been shaved perhaps only 1/4th inch on either side of the incision. The catheter was removed.

The technician who monitored the BAER came to visit. He indicated that even though the operation involved arteries wedged between the VII and VIII cranial nerves, Dr. Payner managed to do the work without obtaining any signals whatsoever from the BAER system.

Saturday, October 8, 2005 – 2 Day’s Post-Op:

 Still no appetite, but most everything else was looking good. The hearing problem was continuing. At noon, the doctor making rounds gave me a choice of going home or staying an additional day. I chose to go home to my own bed, and thus left the hospital about 48 hours after surgery.

Monday, October 10, 2005 - 4 Day’s Post-Op:

 With improved appetite, all the shakiness went away. The blood pressure according to my equipment at home went back to normal numbers for me.

Wednesday, March 16, 2005 - 6 Day’s Post-Op:

 The right eyelid problem has resolved itself and the mild palsy seems to be improving already.

The following picture shows my incision 6 Days Post-Op:


Friday, March 14, 2005 - 8 Day’s Post-Op:

 As of today, I can close my right eye and keep the left one fully open. This was completely impossible earlier in the week.

Monday, March 17, 2005 - 11 Day’s Post-Op:

 The staples were pulled today. The palsy is easing, and was never really that bad to start with. The hearing is quite a bit improved. Whereas earlier I could not tolerate playing the violin because the sound was so repulsive and distorted, now the sound is much closer to the true beauty to which I am accustomed. I am going to give this several more weeks to fully resolve and then have a repeat hearing test. (Still a bit muffled, perhaps underwater sensation, and distorted a bit but much less.)

Wednesday, March 19, 2005 - 13 Day's Post-Op:

 Other than the hearing issues which seem to be resolving and the fact that if I overdo at all, I get completely exhausted, everything else appears normal. Perhaps I am at 99% on the balance /dizziness issue. A small portion of my scalp is a bit sensitive – always feels like the hair is going the wrong direction. I still have a bit of a dull headache in the area of the operation – not enough to warrant Tylenol, but just continuously present. And, not even the slightest hint of a spasm.

All in all I feel I am blessed with my recovery and the results of the surgery. While there are some lingering issues, all should dissipate in time with healing.

Saturday, March 22, 2005 - 16 Day's Post-Op:

 I think the hearing issue is nearly resolved. All other issues are either resolved or very minor. Still an occasional ache in the general area. I am ecstatic, still, NO SPASMS.

The most interesting thing with the face and the hearing is the sense of being inside a self healing computer, and watching what happens as the nerves and brain adjust to the new situation and resolve movements, hearing, etc. It is truly amazing and just further confirms for me that God is real and active in our lives.

Closing Comments:

 MVD is a serious surgery not to be entered into lightly. Going into it with a positive attitude and positive expectations and prayers can seriously impact the results. Also key to this mindset is faith in one’s surgeon. I suggest looking first for skill and second for experience. I am thankful I made the choice to proceed and, I cannot say enough about my surgeon, Dr. Troy Payner. He is right up there with the best on skull base surgery and I would trust his ability anytime.

Permission granted the HFSA to post MVD Diary on website.
John MacBain, October 23, 2005

 

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