My Cholesterol Granuloma Experience: The Surgery

At least after the MRI, I wasn’t left wondering about the unknown. A vascular tumor like a Glomus Tympanicum could be more authoritatively ruled out. My ear problem also wasn’t as simple as just blood, it was in fact a Cholesterol Granuloma – a rare and benign cyst. These are also found to occur at the tip of the petrous apex (the part of the skull next to the middle ear). In my case, the granuloma formed in my middle ear and is luckily more accessible. The cyst is an expanding mass filled with fluids, lipids, and cholesterol crystals (which is what gives off the characteristically bright T1 and T2 images). It’s likely I’ve had this granuloma for many years, but the root cause is hard to accurately determine due to the condition’s heterogeneous nature; however, my previous bouts with chronic ottis media is certainly a suspect.

I asked Doctor K to submit for me a second opinion with another ENT at a different location. Now on my third Doctor (who was thankfully genial and adept), I went to another follow up appointment to review the results of the MRI, and to discuss the surgery plan. Surgery was inevitable by this point, but the path was now fairly clear. A full tympanomastoidectomy was still an option, although I obviously preferred not to undergo such an invasive surgery. Due to the more viscous and liquid-like nature of a Cholesterol Granuloma, as opposed to being a solid vascular mass, utilizing a transcanal method to drain and evacuate was deemed not unreasonable. My eardrum would need to be cut and lifted up to allow access.

After the appointment, my surgery date was set. I had 2 more weeks to wait out, and I did my best to keep my mind off the subject. Ever since I first found out that there was something abnormal inside my ear, I sort of lived in limbo. I stayed off my bikes and refrained from physically strenuous activities. Essentially, I went through the day to day motions, while slowly seeking an answer to this problem. Now with a course of action in place, all I wanted was to get this over with and return to a normal life.

With surgery day upon me (01/24/12), I went into the hospital feeling decently in control. It wasn’t until I was fitted in the gown and laying on the table in the pre-op area that the anxiety started to build.

I had a delicate last-minute discussion with my Doctor/Surgeon to clarify the procedure, and then it was go time. A nurse buried an IV needle into my left arm and I was slowly pumped up with an impressive arsenal of drugs, from morphine to who knows what else. They wheeled me off into the operating room. The last thing I can remember was observing one of the large over hanging lights, and pondering a trivial detail (like where it was made, since it looked rather intricate) to myself. The next thing I knew, I woke up and felt like I hadn’t slept in years. The surgery was done, and I snoozed off for another hour in the holding area. I eventually got back home, took a Vicodin pill, and went back to bed.

The whole surgery experience was quite thorough, the hospital had a whole team of people with different responsibilities catering to me. I still need to go over the details of the surgery with my Doctor next week, but I know that a Myringotomy was also done with an ear tube to provide further ventilation. As for the day after surgery, I could really feel the side effects of the general anesthesia. I felt worn down and my neck and jaw muscles were very sore. I also had a sore throat from the Endotracheal breathing tube placed in me. My ear has moderate pain and pressure, but is otherwise manageable. Currently, I’m bumming it at home and taking it easy until I can recover more. I have to watch out for discharge from the ear and my hearing is muffled.

Although my problem wasn’t life-threatening or a huge deal in the scheme of things, it still underlines the importance of good health. A bump in the road like this can throw off your quality of life measurably. I am eager to put an end to this experience, and to continue life with healthier and more productive objectives for 2012.

My Cholesterol Granuloma Experience: The Diagnosis

This ordeal lasted over 2 months, first originating around Thanksgiving weekend. I felt normal at the time, except for one small thing… I started noticing a “whooshing” heartbeat in my left ear. It was reasonably subtle in the beginning, but became consistent enough to where I was prompted to make an appointment with my general doctor. After briefly researching the subject, I learned that the proper term to this heartbeat sound was “pulsatile tinnitus.” Going into the appointment, I was convinced that the problem was mostly due to earwax, and my doctor was agreeing as well. We tried to flush out the ear without any real results, which is when the doctor saw what appeared to be black “cerumen” impacted against my ear drum. Since the flushing didn’t work, she recommended I see a Head & Neck specialist, or ENT, where they would have more tools to remove this black earwax.

No problem, I made another appointment with the ENT about a week later. In the meantime, I bought the same exact WaterPik flushing tool my general doctor had used, and tried flushing my ear at home. After a few attempts myself, I gave up and decided to just wait for the ENT doctor to handle it. My pulsatile tinnitus wasn’t letting up, and was progressively getting worse. When it came time to see the ENT, I walked in with high-spirits thinking it’d be a quick job, just pluck out this ear wax and I’ll be on my way… Unfortunately things would not be so easy. This ENT Doctor, who I’ll call Doctor K, examined my left ear and immediately asked the question, “why do you have blood in your ear?” I had no answer. What was thought to be black cerumen was certainly no longer the case. In fact, it wasn’t in my ear canal at all – it was BEHIND my ear drum, which was causing the entire membrane to look black (the more analytically correct description would be “blue”, which is why I initially had so much difficulty finding anything under “black ear drum”). Doctor K suggested looking at my Eustachian Tube to see if it was opened properly, which meant numbing my nose and shoving an endoscope up it. My left Eustachian Tube appeared fine, but an unyielding amount of questions remained. The top 2 candidates were: Hemotympanum (bleeding in the tympanic cavity of the middle ear, but from what?) or a Glomus Tumor. I was prescribed steroids and pseudophedrine to help treat the former.

As I sat in the Pharmacy, waiting over half an hour for 2 simple prescriptions to be sorted (it wasn’t even busy that day), I Googled on my phone about this “Glomus Tumor.” I remember reading a site which outlined the prominent symptom to be “pulsatile tinnitus,” and with surgery being the treatment option. I wanted my ear problem to be Hemotympanum, I could make up excuses for myself for the potential causes. Maybe too much stress caused a small vein to burst in my ear? Sure, sounds good. But the longer I searched on my phone, the more likely the possibility of a Tumor seemed to be. I felt numb. The Pharmacy around me was swimming. To accentuate the situation, when I finally got out of that Pharmacy and drove back to work, the pulsatile tinnitus was going off like drums in my ear. When I did get back to work, I sat emotionless and empty behind my desk. This was supposed to be a smooth day, the day I would get my earwax unclogged, pulsatile tinnitus eliminated – and also the day my BMW 135i would be delivered. Taking the car out for a spin when I eventually got home didn’t feel as pleasurable as I hoped it would be, with the news of my ear drowning my mood. Instead, that day was the day I felt utter dread. When you’re living a seemingly normal life, it’s hard to handle getting suddenly turned upside down with the possibilities of tumors and surgery.

I took the medication with no results. My pulsatile tinnitus was growing worse and much more constant. I started to lose sleep because of how loud the noise got in my left ear at night. During the day I had periods of relief, but whenever that noise came back I felt despair. I’d lose concentration – listening to it pulsate and pulsate relentlessly. One of the worst part of this whole experience was the psychological damage caused by that damned tinnitus. You can really endear and appreciate silence after going through something like this.

2 weeks passed so I made another appointment with Doctor K. He checked my ear and almost too excitedly announced, “Yup, it’s still black.” Next step, a CAT (CT) Scan. Doctor K was able to schedule me in for one on the same day. I arrived at the CT Scan location an hour early, so sat idly in the waiting room, trying to fathom the gravity that my situation had become. I ultimately sat and waited for over 2 hours before they got me in, since there were a few higher priority patients ahead of me. Once I did finally get placed inside the machine to get scanned, I hear the technician say, “Oops! We have to pull you out.” Another emergency patient was coming in, so I was pushed aside and had to wait another 30 minutes. My actual scan only took about 10-15 minutes. I also had Contrast Dye intravenously injected (which makes your whole body feel flush and warm).

Doctor K was kind enough to call me back later that day and leave a voicemail regarding the results of the CT Scan, noting that although there was some sort of mass filling my middle ear, it was likely not a Glomus Tumor since the contrast did not enhance it. I could finally take a breath, thinking it might just be blood again.

After about another week, I went back to the Hospital to have an Audiogram done. The results showed a mild conductive hearing loss in my left ear, but this was always “normal” to me. Ever since I could remember, my left ear’s hearing was never as good as my right’s. I went through many ear infections as a child, which I suspected to be the cause of my hearing loss. I then saw Doctor K again and a colleague of his briefly checked out my ear, who thought it was interesting then left. Doctor K showed me the CT Scan and told me it was likely that I had a Glomus Tumor. After thinking WTF?! to myself, I rebutted with my recent recollection of being told this was NOT a Tumor, and did not enhance with contrast. I also wondered how a tumor could be so big, since my entire tympanic membrane was filled black. I was told I needed to get an MRI to know more information. Doctor K noted that tympanomastoidectomy would be the treatment for this tumor, and I asked for an elaboration. One thing you should know about Doctor K, he can be a very straight-shooter in his line of work. If you’ve seen the movie 50/50, he reminded me of the Doctor in the film who talks to the protagonist in a nonchalant, unaffectionate manner. Basically, Doctor K proceeds to robotically list out the procedure: which involves cutting into the head from behind the ear, lifting the ear drum, DRILLING into the mastoid bone, possible hearing bone damage, possible facial nerve damage with permanent paralysis, etc. I know being a Doctor and Surgeon requires a level of desensitization with the work, but this shouldn’t be so coolly reflected upon patients who are suffering. I wouldn’t want to get a stone-faced treatment when getting told bad news about my car, let alone about myself and my HEALTH.

At this point I was starting to lose my patience. I’ve been to the hospital repeatedly over the past month and all my appointments with Doctor K have lasted no longer than 15 minutes. I wasn’t satisfied with this Glomus Tumor being my fate, I wanted some more effort to be put into my case instead of flip-flopping. I went home and did more research myself, where I later discovered that a Cholesterol Granuloma could also be a possibility. I emailed Doctor K this suggestion and he agreed.

It was now Christmas vacation, and I went in for the MRI… which is a whole different animal to a CT Scan. A CT Scan is easy, you just lay inside a giant donut for a few minutes and you’re out. With an MRI, you get strapped down with a thermoplastic mask over your face. The scan time is also much longer, mine lasted about 45 minutes since I also needed another contrast injection. An MRI is also super loud, my ears were starting to hurt by the end of it. While getting placed onto the table, I asked a technician if my MRI would have both T1 and T2 weighted scans. He thought I was showing off, but a distinctive characteristic of Cholesterol Granuloma is hyper-intensity on BOTH T1 and T2 images, which I wanted to make sure of myself.

As I’d later find out, the mass in my ear did indeed show up bright on both.

Irish Steph – Power

Dubstep was cool briefly, but when it comes to this side of music, my preference is still with Electro. Here is a great track by Irish Steph, with an interesting combination of grinding synths, metal guitars, and a hint of classical.

Say Hello to My Little Friend

I decided to make the household more lively by getting a dog. I wanted a breed that is known for its intelligence, with potential to be highly trained. A large size dog was out of the question during my search, we just don’t have the space or capacity. A small, toy dog was also out of the question, because what’s the point in those? So my target size was in the medium range, around 30-45lbs. Lastly, I specifically wanted the coat of the dog to be of the Blue Merle variety. It is more unique and harder to breed (you need to breed a Blue Merle dog with a Normal dog to avoid the risks associated with double merles). I initially wanted a Blue Merle Australian Cattle Dog (like the one in Mad Max), but decided their appearance and build wasn’t quite what I liked.

Then I started searching around for Blue Merle Australian Shepherds and contacted a few breeders. Eventually, I was lead to discover that Border Collies also came in Blue Merles, and the choice became clear and simple. After contacting various Border Collie breeders, many did not have available litters, but one breeder referred me to Pam at Fallon Border Collies who did. Not only did she have a few Blue Merles available, but also a male with blue eyes. Long story short, after exchanging emails for about a week, I met up with Pam (who drove over from Nevada) and picked my new dog.

I’m still trying to finalize a name, but right now I’m settling on calling him “Blue”. Seems to be appropriate enough. When buying a pure breed dog, it’s very important to find a breeder who is genuine, not someone who will randomly pair up dogs to pump out puppies for profit. In my case, Pam was very thorough and really loved what she did. My dog has all the necessary paperwork and pedigree information. The sire was a Champion Blue Merle and the dam was a Grand Champion Black & White.

On the left, with a sibling.

At his new home.

He is quite well behaved for a puppy. Although we are still in the process of house-training him, but luckily we have wood floors.

Parachute Youth – Can’t Get Better Than This

The “Ultimate” Hamburger… WHAT?!

This just goes to show that there are perfectionists and extreme enthusiasts in every activity. The cuisine arts are not my forte, I’ve always been open minded with what I eat, as long as it is delicious. But seriously, trying to break down how to make a HAMBURGER into a science is just ludicrous. Perhaps it may just be my personal perspective on this that is causing bias, but you know how the saying goes – you can’t polish a turd… And yes, a hamburger in the food world is a turd. It’s what you buy when you’re at rock bottom and too lazy to get a real meal. That’s why people are able to make hamburgers in mere minutes, they were practically designed to be fast, crappy food. Buns, patty, cheese, copious amounts of grease, DONE.

After nearly 4 minutes of advocating with sophistication the potential of a hamburger, they don’t even add in the most important ingredient: WHERE IS THE BACON?!

Words of Wisdom

Knowledge can be communicated, but wisdom cannot. A man can find it, he can live it, he can be filled and sustained by it, but he cannot utter or teach it. –Hermann Hesse

Layout Refresh

With Christmas vacation over and the start of the work week, I’ve been preoccupied to make this post sooner. I do feel that it is worthy of an announcement. The finishing touches were put on this new site layout about a week ago, just in time for the New Year. The previous layout was becoming too dense, in my opinion, and I wanted something more light-weight and minimalistic. It’s been a pattern of mine to go with single-column and dark designs. I feel that implementing a sidebar would just promote superfluous links and fillers, a distraction from the main content.

Another key feature of this new layout is in regards to it being Responsive, in other words scalable across virtually all resolution sizes. Try grabbing your browser’s window and shrinking it down. The elements of the site will adjust accordingly, which is great for optimized use on mobile platforms. Responsive design has been fairly popular in 2011, but I feel that it will become a sort of trend in the coming year.

I’ve also added in the Thunder Bolt logo, which I hope will make Grand Mighty more recognizable by it.

Kavinsky – Testarossa Autodrive

Kavinsky is the business. Good use of the synthesizer, gives off a very retro 80′s feel.

Forums are Open!

I was very close to dissolving this website almost entirely. After 2 years of writing, I thought I was starting to run out of material… that my posts weren’t really interesting. Instead, I bought new hosting and converted everything to a new Forum. I thought having a self-running community would be easier, but I soon realized that actually achieving such a goal would be difficult. Having Grand Mighty as just a forum would be risky and probably has a minimal chance of succeeding. This is why I’m jealous of all the big boards out there that have a constant stream of members and posts… their monetary worth per traffic count is far higher than a comparable, normal website.

Rather than pull the plug on everything, I stepped back and gave everything a second thought. For 2 years I’ve maintained this website, why should I stop now? It’s always mainly been a personal blog-type site, and I was never particularly critical about how much traffic I received. This also means that I don’t really care about what I write, since I’m mainly just writing for myself. So screw it, I’m going to keep things going the way they are. It would be great if people found what I post to be remotely beneficial, one way or another, and if not – not my problem. With 2012 on the horizon, here’s to another year of Grand Mighty!

With that said, I didn’t completely pull the plug on the forum idea either. The board is still there, and will just be an addendum to the site. Hopefully it works and becomes active, but we will see as time goes. Help the effort, JOIN THE FORUMS TODAY!

993.

Nothing needs to be touched on a 993 Turbo (aesthetically, anyway). If this car was Guards Red and maybe a little bit higher, it’d be my idea of Porsche Perfection.

Prometheus Trailer

No other environment than Space can quite capture the sense of sheer bleakness. Ridley Scott, famous for the original Alien and other more Earthly movies like Gladiator and Black Hawk Down, he returns to the sci-fi genre to direct Prometheus.

The plot synopsis shows great potential for this movie to be something rather epic. Apparently the release date isn’t until next Summer… so in the meantime, I recommend these 2 very suspenseful films to satiate your other-worldly needs:

Event Horizon (1997)
Sunshine (2007)