My wife recently had a 2.5cm AN removed by Drs Schwartz and Luxford from the House Ear Clinic. I thought I would provide some information about why we chose House, and our experience there.
Since we live within an hour of excellent hospitals such as Johns Hopkins, Georgetown, and George Washington, why travel to the other side of the US for treatment? While we did consult with many hospitals in our area, our phone consultation with Dr Schwartz pretty much made up our mind. You see, you can send your MRI to House, and they'll give you a free phone consult. It was obvious from talking with Dr Schwartz that his level of experience and passion were well above anyone else we talked to. It was also obvious that removing an AN for doctors at House is very routine, while everyone else we talked to seemed to consider it somewhat exotic and/or special. By way of comparison, doctors at House removed almost 300 ANs in 2006 (10% of the total number of ANs diagnosed in the US that year), and performed another 100 skullbase surgeries (~400 surgeries total). Dr. Schwartz performed over 140 of those surgeries - well above the level of experience we found elsewhere. In addition, whenever we asked other doctors how long the surgery would take, we were always quoted 10 - 12 hours. At House, we were quoted 4 - 6 hours. We were also impressed with the lack of bureaucratic red tape we had to deal with in any of our dealings with anyone at House (as compared to most other places we went).
In the end, we realized that it was important to choose a hospital that excelled at treating ANs over and above hospitals that were generally excellent.
Once we made the decision to go with House, I began to make arrangements for my wife with the hospital, St Vincents, where all of the surgeries are performed. My wife has many allergies, including: chlorine (can't use tap water for anything, must stay away from bleach), soy beans (in almost all american food), and a few others. St Vincents assigned a very experienced RN to work with me on these issues. She arranged for the food services people to prepare special menus and order special food, briefed the staff that would be providing care, arranged for special linens, etc. She and the other staff at St Vincents were more than happy to go out of their way to make this work for us, and they succeeded in doing so.
Let me back up a bit. Due to my wife's allergies, we were originally very opposed to taking a surgical route, as even staying in a hotel is quite an ordeal. However, after every doctor we talked to recommended the same course of treatment (surgical resection via retrosigmoid approach), it was obvious to us that going with House/St Vincents was the best option in this respect, because it was obvious from talking to them that they were there to work with us and make this happen. At other places, it seemed that we would be fighting some sort of bureaucracy to make things happen.
Once we arrived in LA, we set up shop at the Seton Guest Hall, which is on the grounds of St Vincent hospital - a very short walk from the main building. Each room is spacious, with a queen size bed, a sleeper sofa, a TV (no cable), a small fridge, a bathroom (shower, no tub), and plenty of places to unpack your stuff. The common kitchen (shared by all) has a full size fridge, microwaves, a sink, and a toaster oven (no cooktop or oven). In my opinion, the odd numbered rooms are better than the even numbered ones, because they have a nice view. While there is no WiFi, there is a place to hook up your laptop on the 1st floor (ethernet), as well as on the 9th floor lounge of the hospital. If you have a car, you can get a 7 day parking pass for $18. There is parking right behind Seton in a parking garage. And don't miss the basketball court in the sub-basement (only accessable by elevator).
If you're into excitement and stuff to do, Seton is not the place for you. However, if you're looking for a very quiet place to stay to recuperate, with lots of supportive folks going through the same thing you're going through, this is the place.
The St Vincent's campus is located in the middle of a Latino, working class neighborhood. While I have heard it called 'seedy', I would not say it is a bad neighborhood, and I never felt unsafe there. I have been to bad neighborhoods, where you only seem to see idle young men and boarded up buildings. This neighborhood is not like that. You see plenty of women, including moms with kids, walking around. I never saw any idle young men looking for trouble.
For food, there is the cafeteria in the hospital. If you're into fixing it yourself, going west on 3rd street a couple of miles gets you to Vons and Ralphs. Vons is a truly great grocery store. If you go further, you'll hit Trader Joes and Whole Foods (on the outskirts of Beverly Hills - about 5 miles). There's also a very nice mall across from Whole Foods. The most convenient pharmacy is on the 6th floor of the professional office building (right next to Seton), but it's only open 9-5, M-F. Buses run all the time on 3rd street, but we always used our car.
Seton is also very convient to get to emergency post-operative care. St Vincents has an emergency room that is mostly used for after hours care of patients under the care of St Vincents physicians. When my wife needed to go in late at night a week after the surgery, I just put her in a wheel chair and wheeled her over - she was taken care of immediately, and a doctor from House was there to work with the ER personnel. This is NOT your typical ER with hours of waiting in a noisy waiting room.
Our first full day in LA was taken up with testing at House, which is just across the street from St Vincents. Since more than half of the patients at House come from outside of LA, they are very much set up to handle travelers. All I have to say about testing at House is that it runs like a machine - effective and efficient. The coordination between St Vincents and House is nearly seamless. We went through all of the testing in 7 hours, which culminated in seeing Dr Stefan. Dr Stefan is an internist, and is the one who generally takes over from the surgeons to get you back on your feet. He's also the gatekeeper - if there's any doubt about your fitness to undergo surgery - he'll keep it from happening. He's very thorough, competent, and experienced. Of course, you also see the surgeons who will be operating on you. It's obvious that they know what they're about, and what needs to be done.
On the next day, they do the surgery, which normally takes 4-6 hours. Following surgery, you will be in the ICU for 24 hours. In the ICU, there is a nursing assistant assigned to watch each patient (they sit right next to the bed), and visitation is limited. The nurses that were in the ICU while my wife was there had 17 - 25 years of experience, all at St Vincents. They like what they are doing and are good at it.
In our case, the surgery took 8 hours, as the doctors had a very tedious time getting the tumor off my wifes facial nerve, which had been flattened by the tumor.
After the ICU, you will be in a private room in the hospital for 1 - 5 days. Without exception, all of the nurses and nursing assistants were above average, if not excellent. However, the thing that impressed us even more than their competence was their compassion and kindness. While they have visiting hours, it is not unusual for a spouse to spend a night or two with a patient. Of the patients that were staying at Seton, most were released from the hospital after 2 days, although you should plan on 5. Of all the hospitals I have been to, this hospital was the quietest. However, it is still a hospital, and you will get woken up periodically as the staff cares for you.
Going back to Seton was great for my wife, as it is very quiet and peaceful. We never heard any noise from any of the adjoining rooms. Its a place where you can focus on getting well. Since Seton is on the hospital grounds, a hospital transporter will wheel you from your hospital room to your room at Seton.
Immediately following surgery, it is best to avoid doing things with your eyes, especially reading (even computer or TV can be bad). Surgery cuts the vestibular nerve, which plays a part in controlling your eye.. Audio books are your friend.
Once you leave the hospital, you will be on some strong steroids. These steriods can make you feel like YOU MUST DO SOMETHING. It is important that you don't. Many people at Seton had the experience of overdoing it, then having to not do anything for a couple of days as they recovered. Do the exercises that they tell you to, and keep other activities to a minimum. The steroids can make you feel normal, and you may be tempted to not draw all of the medicine that is prescribed - draw all of the medicine as soon as you can. You may find that you suddenly need those strong pain killers a few days later.
While it is generally safe to get back on the plane 10 days following the surgery, I would recommend that you schedule your return flight for 14 days after. If you need the extra days (we did) it's much better. If you don't, there are plenty of things to see in the area (we went to Malibu on the last day - very nice).
The surgery was very successful for my wife. Prior to the surgery, she was dizzy, and had facial weakness/numbness. All of these symptoms went away following the surgery. This would not have happened with radiosurgery, as the tumor would have still been there. While she had perfect hearing prior to the surgery, she lost all hearing on the right side, despite the heroic attempt by the surgeons.
Many others had the exact opposite happen. Since my wife's vestibular nerve was gone prior to the surgery, the surgery stopped bad signals from getting to her brain, which eliminated her dizziness. Most people still have at least some vestibular function, and have a period of dizziness after the surgery. Likewise, removing the tumor removed pressure on her nerves, which removed the numbness and other symptoms. Most people have the opposite effect, as the surgery disturbs the nerves and causes a temporary period of facial numbness.
This was exactly the prognosis offered by Dr Schwartz when we first talked to him (although he stated that there was a 50% chance of retaining usable hearing in my wife's case).
We are very happy with the care we received at House / St Vincents.
