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:

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.

1 comment:

  1. Wow! Great blow by blow description. Glad that it went so well. I was thinking of you with healing energy. Sending wishes for a Merry Christmas and fabulous 2010. Lots of love, Judith