Throat Blog — Operation Voice Restore, Part I

Finally, back to a Throat Blog post that is actually about my throat. We’ve been all over the body…lungs, kidneys, gallbladder, and now circling back around to where this all started, my throat.

To refresh, my original tumor was in my throat…it invaded and destroyed most of my thyroid cartilage and, at its peak, went nearly from cricoid to hyoid vertically, and wider than my larynx laterally. It was big. Treatment was loads of radiation over a 12-week period, which successfully destroyed the tumor, however a lot of damage was left behind.

Notably, my thyroid cartilage was almost totally obliterated and my vocal cords were welded together…an effect of the inflammation and damage from the radiation therapy. My cartilage has surprisingly restored, somewhat. The last good image I had of it, it was about half as tall and twice as thick as a normal thyroid cartilage, and it was still reforming.

However, my vocal cords needed more intervention. I’ve been stuck between a whisper and a rasp, now, for over a year. While that works kind of OK in quiet rooms, anywhere there is any ambient noise, I really cannot participate in conversations (or order food). I’ve adjusted a lot, but actually being able to project some volume would really be great. Whispering at idiot drivers just doesn’t have the same effect as yelling.

So, Tuesday I went in for Operation Voice Restore, Part I. This part consisted of a day surgery where my vocal cords were cut apart with a CO2 laser, then a plastic keel was put in place to hold them apart while they heal. Technically, I had “laryngoplasty” which is the same procedure they use when going through gender reassignment surgery to raise or lower ones voice. Keeping my current gender, thank you, just give me a voice (preferrably more on the Isaac Hayes end of the spectrum). My sister went with me and spent what I’m sure was a wonderful morning drinking coffee while I slept.

Step 1 was to get me intubated and to block my airway so that I wouldn’t aspirate anything during the procedure. (This was all done under complete sedation…I knew none of what was happening at the time.) Here’s a shot of what things looked like just before the cut. The metal tube (blocking my airway and also providing me with oxygen) is actually pulling my vocal cords apart, some. Normally I would not have this large of an opening (pre-procedure).

Next, the surgeon used a laser (insert air quotes if desired) to separate my vocal folds. The laser was able to cut and cauterize at the same time, so not really any bleeding.

Finally (for this stage), a plastic keel was secured in place to hold my vocal cords apart during healing. There is another plastic piece attached to the outside of my throat and the two pieces are sutured together to hold it in place.

When I woke up from the procedure (and I wake up very quickly from these modern anesthetics), I was still on the procedure table, in the process of being moved over to a gurney. They wheeled me into post-op for about 30 minutes, then back to the prep room where I’d left my clothes. Pain was moderate, but building, so I made the first of two mistakes of the entire procedure. I took a 10mg Vicodin. On an empty stomach.

I’ve done that before, but then immediately slept for several hours. This time, I had to get up, get dressed, and get out. I was fine while I was in the hospital bed, but as soon as I got up to get dressed, nausea hit me. I actually allowed them to wheel me to the bathroom (where mistake two happened…no, not what you are thinking), then down to the curb where my brother-in-law was waiting to drive me back to their place for recuperation.

We got about 10 minutes away when I started looking for my phone. Nowhere to be found. We called it, and couldn’t hear it ring, so was certain it was back at the hospital. But, where? Find My Phone said it was out on the front lawn of the hospital. I’ve generally found that app to be exceptionally accurate (identifying which room in my house the phone has hidden itself in), but the hospital pretty much whacked all the GPS signals, so in addition to the spot on the lawn that was the most probable location, it also had a circle of doubt that ranged 1/4 mile to 2 miles, depending on when I looked.

Eventually, we tracked it down to the bathroom on the 3rd floor, where the staff had just found it. Between turning around, stopping before driving back to the hospital to give the truck a good search just to be sure it wasn’t there with the ringer turned off, stopping again so that I could empty what little had been in my stomach (and was entirely water) onto some poor businesses parking lot, in and out of the hospital a few times trying to figure out where it was…a 20-minute drive back to their house turned into a nearly 2-hour fiasco…all on me. And the Vicodin, which I should have passed up.

When we got to their house, I found the first horizontal and relatively comfortable surface I could find (couch), covered my head with a pillow, and passed out until early evening.

Now, it has been a couple of days, and my lingering aftereffects are a sore throat (duh!), a slightly numb tongue (just the right half…I suspect a nerve was compressed when they dammed my mouth open), and a need for a nap (didn’t really sleep well due to the nagging pain which, while not agony by any means, was enough to prevent deep slumber). I am also having a bit of trouble swallowing, as my throat is pretty swollen, right now, but that should get better pretty quickly.

I am back to a whisper only. And, too many people are whispering back to me. I did not realize I was such a trend setter.

On 12/11 I’ll have a much shorter procedure where they’ll knock me out, again, take out the keel, then wake me up. Should be quick, and I should be able to get some sort of voice going after that. Not getting my hopes up that it will be my old voice (doubtful) or even that it will be a full voice. But, if it is better than what I’ve had for the past year, that will be enough, for now.

Throat Blog — Too Busy November

Well after that slow last week of October, November has been way too eventful. Two weeks after that last ER visit, I had the same pain. Tried to just “gut it out” since ER didn’t really do anything last time. But, this time it progressed to nausea/vomiting. So, another drive to the ER. They ran some tests but in the end the pain went away on its own, and they sent me home.

The promised GI visit had happened, and his thought is that the cause of my steatorrhea could be SIBO (small intestine bacterial overgrowth), so I’ve been taking antibiotics for that. It is possible that where my intestines were reconnected last year has either narrowed or kinked, causing very slow movement, there, allowing the wrong bacteria to flourish. Well, that is the theory, anyway.

Now, come to a couple of Fridays ago, when I again woke with upper right quadrant abdominal pain that slowly got worse during the day. This time, I bore it through two bouts of nausea/vomiting (5pm and 1am), but then checked and found I had 101.5F fever. Once again I trekked to the UTSW ER, where they gave me morphine. Did another CT scan. And, at 5 am cut me loose with a prescription for percocet (aka oxycodone). I knew better than to just pop one of those, despite really needing something for the pain. So, I drove to a Starbucks not far from my house and had some breakfast and then popped a percocet and waited for it to do its magic.

Sat in a chair at Starbucks with my hoody sweater pulled up and my e-reader in my lap pretending to read. Actually out like a light. Until 8:45AM, when my phone range. It was UTSW ER. They said I needed to come back. Well, I was still way too doped up to drive, but they said as soon as it wore off would be OK. A 2nd radiologist had looked at my CT scan and felt that there was something else to investigate.

So, around 10AM, I again traced that too-familiar route to UTSW ER, where they first indicated my gallbladder should probably come out, but they were waiting for the surgeon to get out of surgery to consult. They also wanted to do a HIDA scan…something that would check the function of my biliary/gallbladder system.

The surgeon came out and said that she really didn’t think gallbladder removal was the best option, right now, and besides there were some other things that were much less invasive that could probably be done (but she didn’t say what those things were). I agreed that not cutting into me was preferable, if there was a reasonable alternative, and she went on her way. They then admitted me to the hospital.

On Sunday, they then trucked me into a procedure room for the HIDA scan. They basically inject a tracer that binds to bile, then use a special camera to watch the flow of bile for a couple of hours. After 2 hours of not much movement (I was watching on a monitor the whole time), they injected me wit some Morphine, which causes the gallbladder to compress and also otherwise accelerates bile activity. I watched for the next 30 minutes as bile moved into and through my duodenum into my jejunum and then across to just under where the gallbladder is (upper right quadrant abdomen) where it slowed substantially. By the end of the 30 minutes, no bile had moved past that point.

Radiologist report said that the gallbladder was never visualized on the HIDA scan, which means that the bile ducts are blocked. So, they told me that they would be doing a procedure to drain my gallbladder (cholecystostomy tube). They explained that a tube would be installed allowing th ebile in my gallbladder to drain into an external bag. Ooookaaay. How long does it stay in? Well, they said. At least 6 weeks, but probably forever. Wait, what? Forever? No. I absolutely told them repeatedly that that was not an option. I’d rather them just take out my gallbladder.

On Monday I was wheeled in for the cholecystostomy procedure. On the way and in the procedure room I told pretty much everyone that I would prefer a cholecystectomy (gallbladder removal). But, there is a chance that after 6 weeks the tube can come out and my gallbladder will be fine. In any event, they have also scheduled me to see a surgeon for what they are calling “elective cholecystectomy.” Not sure if insurance will cover it if it is called “elective.”

Tuesday, finally, they allowed me to go home. The delay was that I had not eaten anything but a little jello since Friday noon. They wanted to be sure that I could handle solid food.

So, now I have a lovely bag hanging from my side collecting dark green bile. They led me to expect 2-5 cups of collection per day. I’ve been lucky to get as much as 3 or 4 tablespoons of collection. Not sure if that is a good thing or a bad thing. Went to dinner with friends last night, and just clamped off the tube and took off the bag for the evening. Didn’t appear to have any ill effects (it did have some bile ready to go when I reconnected, but not much).

This Tuesday I will have my glottic web surgery…step 1 in restoring some voice. They will cut my vocal cords apart (damage from radiation welded them together) and put in a “keel” to hold them apart for healing. Then, in 2 weeks, they’ll perform step 2 and take out the keel and I should be able to start using my vocal cords, again. Maybe not 100% at first, but anything will be better than the low-volume rasp I have now.

Well, this was a very big update for November. I shouldn’t wait so long between updates. But, I have been super busy at work, and the holidays plus ER visits have shortened my time at the desk. I’ll not be able to talk at all for 2 weeks, so maybe that will translate into more sitting and typing time. We’ll see.