Tuesday, December 29, 2009

Hurry Up and Wait

Just got back from my follow-up with Dr. King. The good news is everything looks great. My vocal cords are bruised (totally normal under the circumstances), but other than that they are peachy. Getting that bloody scope up my nose was an ordeal, but that's never going to change. He told me today that I've got the most difficult sinuses to navigate of any person he's ever seen. Lucky me! That explains why I am also the best patient because I tolerate the pain so well. Again, lucky me...

He tested their function and both sides are moving normally with no indication of scarring. The way he checked that was to have me sing a long "eeee" and with a strobe light he captured the cords' movement. The strobe allows you to see the cords undulating together. If you didn't use the strobe they would appear to be stationary because they were moving at a rate of about 210 cycles (hertz) per second (that's the pitch I was hitting so it would vary accordingly). The undulation reminds me of a stingray moving through the water. If the tissue scarred that rippling effect would be impaired and that would be a very, very bad thing.

The somewhat bad news is he wants me to see me again and in the meantime he wants me to continue to rest my voice by speaking very little. He also said I have to refrain from singing until that appointment which is about ten days before the Swallow Hill show. I have no doubt I will be able to perform for that show provided I take care of my voice in the meantime. Seeing as that is my number one priority in life right now, it shouldn't be a problem.

The quality of my voice as far as I can tell is completely normal. Neither Tom nor I hear anything unusual and the hoarseness is gone. It's starting to sink in that the surgery really was a success. I bought a bottle of Demi Sec champagne for New Years, but I might just save it for Swallow Hill.

Monday, December 28, 2009

The Sound of Silence

On Saturday afternoon, I decided it was time to break the silence of my vocal rest. Dr. King told me to rest for at least 48 hours. I think he felt bad that if I went the three to four days he originally prescribed, I wouldn't be able to talk on Christmas. But I didn't want to take any chances so I decided to go the full four days.

As it came time to speak, I found myself increasingly nervous about it. My throat felt completely normal, but I kept wondering if my voice would be drastically different or really rough. After all, I'd just had a few sections of my vocal cords toasted with a laser. The damage wouldn't be healed in only four days. Still, I was a little surprised when I did speak to hear how hoarse I was, considering how normal I felt. My voice was a little more hoarse than my worst days with the polyp, and it definitely took a bit more effort to speak than usual.

Three days later, it's sounding much improved over the weak, hoarseness of Saturday. Definitely trending in the right direction. Tom thinks it sounds pretty normal, but my perception isn't so rosy because I feel how much effort it takes to talk. I'm trying hard to speak properly, using my support rather than letting the voice box do all the work, particularly if I have to speak with any volume. Even though I'm not talking very much, I feel my voice growing fatigued. I'm sure the muscles in my throat are a bit out of shape, since I've been dealing with the hoarseness for so long and I've also spent a lot of time before the surgery speaking as little as possible in the hopes that vocal rest would help.

It's easy for me to get concerned, as worrying is almost a hobby for me, but I keep telling myself that I've got to give my body time to heal. All I have to do is look at the photo of the finished procedure. It looks like someone put their cigarette out on my vocal cords, complete with a few black singe marks along the edges of the treated areas.

Tomorrow is my follow-up appointment. I'm not looking forward to having that damned scope stuck up my nose again, but I am anxious to see how things are healing. I'm not sure when he'll give me to go-ahead to start singing again. I do know that it's going to be a bit nerve-wracking, though, because I'm going to be hypersensitive to any fatigue, pain, or unusual sound quality for awhile. I can't wait to be able to sing again, but I also don't want to push it and damage my voice.

One thing I've learned in this whole experience is that I'm not alone in having this problem. I just discovered that Rosanne Cash couldn't sing for 2 1/2 years because of a polyp, and the list of artists who have had polyps or nodules is like a "who's who" of great singers. Luciano Pavarotti, Freddie Mercury, Whitney Houston, Mariah Carey, Robert Plant, Bonnie Tyler, Elton John, Rod Stewart, Sarah Brightman, Bette Midler, and many, many others have had nodules or polyps. And then, of course, there's Julie Andrews (whom I consider my first voice teacher thanks to the hours I spent as a child trying to sing "The Sound of Music" note for note, just as she did). Tragically, she lost her ability to sing thanks to a botched surgery on her vocal cords. It's not a club I ever wanted to join, but at least I'm in good company.

For more info on singers with nodules or polyps, check out this Wikipedia page:

Wednesday, December 23, 2009

Hit Me With Your Best (Laser) Shot

For the not-so-curious, the short story is that the laser procedure was a success, the chance of the polyp returning and me needing surgery looks slim, and after voice rest followed by a gradual return to speaking and singing, I should be fine.

If that summary left you with questions or, like me, you’re going through “Grey’s Anatomy” withdrawals during the holiday season, read on as I give a detailed account of my vocal polyp removal.

I was diagnosed with the vocal polyp using a procedure called a laryngoscopy. A tube with a fiber-optic camera inside it is threaded through a nostril and down your throat giving the doctor a birds-eye view of your vocal cords. The tube isn’t passive, the doctor is actually able to control the tip, making it flex and bend when needed. The camera’s progress is shown on a large computer monitor and the doctor records the procedure so he can show you video and provide still photos later.

A topical anesthetic, lidocaine, is sprayed up your nose and drips down the back of your throat to deaden the tissue so you don’t feel any pain or gag. The lidocaine is cinnamon scented, but tastes pretty bad, sort of like ingesting some kind of household cleaner. I don’t know why they bother to scent it. It’s kind of a sneaky trick because the scent leads you to think the taste will be pleasant. It’s not.

I suspect the average person having this procedure wouldn't have the sinus discomfort I have, but I'm special (special = cursed). One area of my sinus cavity is extremely narrow, so the challenge was not the procedure, but threading the tube with the fiber-optic camera and laser through my nose. At the time of my first exam, Dr. King had to stuff cotton balls soaked in lidocaine up my nose to deaden the area further. Once it was sufficiently numbed, it was uncomfortable, but not painful getting the tube in. Unfortunately, the scope for the laser procedure was bigger. Last time, we went through the right nostril which in some areas is wider, but is also much more crooked. The left side is straighter. He tried both and eventually made it through the left. Getting the camera in proved to be the greatest challenge in the whole procedure.

It definitely sucks that my sinuses are constructed this way, but I can’t complain too much because that unusual structure may be a significant factor in the quality of my voice. When you sing, your palate, nasal cavities, and bone structure give resonance and color to your tone. I’ve heard of famous singers who needed work on their noses but chose not to have surgery because they were afraid of the effect it would have on their voice. I’ve never liked the looks of my nose, but am learning to value it for reasons other than its appearance. I also have a very keen sense of smell which is both a blessing and curse.

My first exam was done just by the doctor. In comparison, the laser procedure was a party. Tom was there for moral support and sheer curiosity. Dr. King’s assistant was there to provide a second pair of hands and the laser guy (didn’t get his name) was there to man that piece of gear.

Before they inserted the scope, they put a tiny tube through a channel so they could apply lidocaine directly to my vocal cords. That was a strange and slightly unpleasant experience. The doctor had me sing “eeeee” while they dripped the lidocaine. It sounded weird, like gargling, but it also makes you cough as some of the lidocaine gets past the cords and into your windpipe.

Once the vocal cords were deadened, they removed the lidocaine tube from the channel and threaded in a fiber-optic line for the laser. We all had to wear funky glasses during the procedure. I assume it was a safety measure in case the tubing between the laser machine and the scope cracked or somehow there was a release of stray laser beams. I kept expecting to see laser beams shoot out of my mouth, but that never happened (wouldn’t that have been cool!).
At this point, I became a human video game for Dr. King and he got to show off his exceptional shooting skills as he used a foot switch to zap the polyp. He started around the edges and worked his way in until the polyp was completely removed.

The laser guy sure has an interesting job. He carts this expensive machine from one doctor’s office to another, as needed. It looks like a big computer tower and his job, other than to chauffeur it, is to run the machine. The doc tells him the setting he wants and Laser Guy makes it so. Doctor: “Give me 25 watts, 30 millisecond pulse.” Laser Dude: “25 watts, 30 milliseconds, that’s 2 pulses per second.” I felt a little like the warp drive on the Enterprise getting a tune up.

I couldn’t feel the laser pulses on my vocal cords, but I sure could smell them. It smelled more like an electrical fire than what I would imagine burning flesh smells like. I was waiting for the doc to mention something about the smell, but he never did. I assumed everyone could smell it, but I learned later that Tom couldn’t. Maybe the doctor could because he was closest to me, but I suspect I might have been the only one who got to experience that particular element of the procedure.

When Dr. King finished with the polyp, he looked over the cords carefully and saw some suspicious blood vessels on the other cord. He said they looked like possible precursers to polyps so he suggested that we get them, too. I agreed, even though I was starting to feel like the lidocaine was wearing off. Whenever I swallowed, my epiglottis was closing on the tube and it was really starting to bother me. I wasn’t instructed to avoid swallowing, just to try to relax and focus on my breathing, but I did my best not to swallow unless I had to.

When the tube was finally removed, Dr. King asked me how I felt. There was this long, painfully silent moment when all four faces were staring at me and I was thinking “how the hell am I supposed to answer that without talking!” Finally, the doctor realized why I was hesitating and he said it was OK if I talked a little bit. My voice was pretty croaky because it was still numbed out, but it worked. He then proceeded to show me some of the footage, and grabbed some stills to print for me. (Hey, if I’m spending $1,000 I should at least get some pictures to gross out my friends. They aren't bloody, but some folks may find them disturbing so viewer discretion is advised. Keep in mind that this is a view from above and the cords are shown upside down so the right cord is on the left and vice versa. The top two pics are of the polyp prior and during removal; the bottom left shows the area after removal and the suspicious blood vessels on the left cord; and the bottom right photo shows the cords after both sides were treated: http://www.trinitydemask.com/polyp/vocal_polyp_removal_4web.jpg)

Dr. King and Laser Guy (I really should have remembered his name) seemed thrilled at the outcome. Everyone was beaming, and I probably was too, but more from relief that it was over. The polyp was completely removed and it seems doubtful it will come back. The potential for other polyps on the left cord were zapped as well. It hadn’t really sunk in that it appears to have been totally successful, and I won’t really believe it completely until I actually hear the results.

Right now, I’m on voice rest for a few days and I go back in for a follow-up exam next Tuesday to see how it’s healing.

Tom has been taking good care of me, but he’s virtually useless when it come to lip-reading or hand signals. I would never want to be on his team in a game of charades. He also occasionally answers me silently because he forgets that he can talk. It would be frustrating if it wasn’t so hilarious. He’s doing his best, though, and I appreciate the effort. It’s so good to have him home and it’s an enormous relief to finally have this procedure behind me.

Tuesday, December 22, 2009

Two thumbs up

I've learned that when I can't talk, thumbs up is the most instinctive way for me to say "yes." An enthusiastic "yes" is two thumbs up and I've been using it a lot today. Funny, I never thought I was a "thumbs up" sort of person.

The laser procedure went extremely well and the doc said the prognosis is very good. He also said I was his favorite patient of the day because it went beautifully and I was so good (good = tough). The biggest surprise of the day was the level of discomfort/pain, including the pain I'm in now. Nothing really bad, but definitely unpleasant. I feel like I just caught a nasty virus. My throat hurts, it hurts to swallow, and my sinuses burn and ache. Other than that, I'm doing very well and plan to detail the whole procedure here tomorrow.

Tom was able to watch the whole event so I can relay not only my experience as patient, but his input as an observer. It was a very interesting experience for both of us. I'll fill you in tomorrow.

Thanks again for all the prayers, thoughts, good wishes, and concerns!

The big day has arrived

I'm having the laser procedure to remove my vocal polyp at 1:00 pm today. I'm a little nervous, but mostly anxious to finally be doing something about this problem. This is the closest I've come to surgery since I had my tonsils removed when I was four or five years old. And if the procedure is successful, I won't have to have surgery on this polyp in the coming months.

Tom is finally home after two months with his parents in Illinois and I'm so grateful to have him here with me now. Of course, he's enjoying being home and I'm sure he is looking forward to 3-4 days of absolute silence from me. That reminds me, I have to grab a steno pad before I leave so I have some means of communication.

I'll post again soon to report on the procedure. Wish me luck!

Tuesday, December 8, 2009

A silver lining

First of all, I want to thank everyone who emailed or called me with your well wishes. I have been overwhelmed and humbled by your kindness and concern.

It is true that every cloud has a silver lining.

I learned Monday that I am indeed without health insurance. It terminated as of December 1. Great timing, huh? Tom has not been able to get an answer regarding whether we can get COBRA coverage or not because of the buyout of his employer. It looks like I will probably be without insurance until January when Tom goes to work for the new company.

Dr. King's office was ready to schedule the surgery for this week, but I told them I'd have to wait a bit to figure out what to do. Since I didn't know about the insurance problem when I had my exam, I didn't discuss the ramifications of waiting with Dr. King. I also had thought of other questions in the meantime so I arranged for a phone consultation.

He had mentioned when he discovered the polyp that lasers have sometimes been used on polyps. I asked him to elaborate on that comment and he said that because of the size of the polyp it's possible a laser could be used to shrink the blood vessels supplying blood to the polyp. This procedure would be a fraction of the cost of the surgery, and could be done in the office under local anesthesia while I'm awake. No surgical center or anesthesiologist to pay, and no risk of surgical complications like a reaction to the anesthesia or infection. The only risk would be the money for the procedure if it doesn't work. If unsuccessful, I'd still have to have the surgery, but it would be done later after I am healed from the laser procedure and, hopefully, when I have insurance coverage again.

Needless to say, I'm thrilled at this news. I'm not sure when I can schedule the procedure since the laser has to be brought to the facility. I’ll keep you posted as I learn more.

In addition to the laser procedure, I'm also taking a homeopathic remedy supplied to me by homeopath and acupuncturist Joseph Ellerin who is the partner of my friend Galen Williams (founder/owner of the Louisville Clinic of Traditional Chinese Medicine). Perhaps the remedy, combined with all the prayers and healing energy being sent my way, will manifest in a miracle, or at least ensure that the laser procedure is 100% successful.

Sunday, December 6, 2009

Mystery solved

I've been experiencing some hoarseness and vocal problems for about two months and was finally able to see an doctor (Dr. King at Boulder Valley ENT) for an endoscopy on Friday. We discovered that I have a polyp on one of my vocal cords. It's small, but is unfortunately not something that will disappear with vocal rest. I will have to undergo outpatient surgery to have it removed. At this point, I'm waiting for the doctor's office to schedule the surgery. It's supposed to take place as soon as possible, but I don't know what that means in hospital terms.

Essentially, a vocal polyp is a blood-filled blister. Untreated, it would eventually cause irritation and quite probably a nodule (callous) to form on the opposite cord. It could also enlarge and cause further problems. The surgery involves opening a flap of skin on the polyp, draining it, and closing the flap. Sounds simple, right? It would be if it was on my toe, or just about anywhere else on my body.

Polyps are usually caused by overuse or trauma to the vocal cords (too much talking, singing, or screaming, or singing while sick). While I have certainly abused my voice in the past (singing for 4 hours straight in smokey bars, screaming at concerts, talking over music at parties with friends all night, etc.), I haven't done anything even remotely strenuous in the last few months (or year, for that matter). There is a good chance the polyp may have occurred due to acid reflux, so I'm being treated for that as well. I haven't really had symptoms of it, but apparently, it can often occur without the typical signs of heartburn.

The prognosis for a full recovery is very good. After the surgery, I will have 3-4 days of complete vocal rest and then weeks of voice therapy, gradually speaking a little each day (and I would imagine involving some exercises). I'm unclear at this point exactly how long it will be before I can perform again. Now that I'm over the initial shock, I have more detailed questions to ask Dr. King.

Perhaps more shocking than the diagnoses was the news that I may not have health insurance coverage anymore. Tom is still trying to determine if I'm covered or not. His employer sold the company to another company about the time Tom went to Illinois to help his dad recover from quadruple bypass surgery (he is still there, by the way). His start date at the new company was moved to January and he was told that he would have insurance in the interim, but when he investigated it last week to be sure he discovered that we may have been dropped. When it rains, it pours...

I'll post more information as I get it. In the meantime, I welcome all the crossed fingers, warm thoughts, and prayers you'd care to send my way.