January 30, 2026 - Laryngologist

It’s been a busy couple of days with things medical, so let me bring you up to date.

Yesterday morning, Claire and I went to one of Dr. Mady’s offices, to have a nurse remove the surgical drain. I felt much better instantly, having gotten rid of that little soft-plastic millstone around the neck.

The removal itself went very smoothly, but the nurse was concerned about the amount of swelling and inflammation both above and below the surgical dressing that formed a tight collar on the front side of my neck. She called in one of Dr. Mady’s residents who happened to be on site. She took a look at it and suggested we drive immediately from the Johns Hopkins Medicine Greenspring location, north of Baltimore, to the outpatient center at the main Johns Hopkins Hospital. Dr. Mady was seeing patients there that day, she explained, and she thought she’d want to see me immediately.

So that’s what we did. Dr. Mady saw me just after noon. She and her resident carefully removed the tightly-stretched dressing. Then they gently poked and prodded my swollen neck. She explained that she wanted to try to remove some of the accumulated fluid. They numbed my skin with lidocaine and Dr. Mady used an ultrasound machine to guide the needle insertion. She wasn’t able to remove much fluid, but she said every bit helps. She also prescribed an antibiotic for the infection.

Having heard me speak with my hoarse, breathy voice — now over a week following the surgery — Dr. Mady asked if I’d be willing to see a laryngologist sooner than my February 3 scheduled appointment with Dr Hillel.

So, first thing this morning, while it was still dark, I drove back through the ice-choked Baltimore streets to that same location, for an appointment with Dr. Anirudh Saraswathula. He used the same sort of through-the-nose camera device Dr. Mady had used, pre-surgery, to examine my vocal cords. I could see on the screen the same problem she’d identified earlier: my paralyzed left vocal cord remains rigid, while the right vocal cord moves freely. (Take a look at this image of someone else’s vocal cords I found online; it looks very similar to what I saw on the screen.)

Speech happens when the vocal cords move back and forth, opening to let air through and then closing to cut off the air flow. My problem is that, because the paralyzed vocal cord is stuck in the open position, the two vocal cords no longer meet in the middle. The air passing through the now-constant opening between them is what gives my voice its breathy character.

Dr. Saraswathula explained that, based on what he’d read in my chart about my surgery, the thyroid-cancer tumor had been “deeply involved” with the nerve. Dr. Mady saved the nerve, but it remains to be seen how much it will recover from the damage the tumor did to it. That process of recovery will take several months at least, and it’s impossible to say how much (or, indeed, if any) improvement in my voice will occur. 

He suggested, and I agreed to, a procedure whereby a bulkening agent — similar, he said, to what fashion models use to enlarge their lips — will be injected into my paralyzed vocal cord, so the gap between the two will close when the healthy vocal cord moves towards it. The effect will last several months. This won’t interfere with whatever nerve recovery may naturally take place during that time, and may help me speak more clearly in the meantime. If it turns out, down the road, that there’s little or no lasting improvement to my recurrent laryngeal nerve’s function, they’ll then have the option of inserting a permanent implant into the paralyzed vocal cord.

I'll be awake for that procedure, which takes place through the mouth with the vocal cords numbed by lidocaine spray. It will be helpful for me to be awake, so the doctor will be able to observe the vocal cords as I speak.

So, that’s what’s ahead. My appointment with Dr. Hillel at the Greenspring location is still on the books for February 3. Dr. Saraswathula will consult with Dr. Hillel to see if perhaps that doctor could give me the temporary injection in the office that same day. 

He also suggested I see a speech therapist. So that will be in my future as well.

January 24, 2026 - Softspoken

I've been home from Johns Hopkins Hospital for a couple of days now. It's a slow recovery from surgery, but that's what we expected. I was discharged with a surgical drain still in, so Claire and I are dealing with that at home. So far, so good with keeping it emptied and logging how much fluid it produces.

Once the drain is no longer draining, the plan is for us to stop by Dr. Leila Mady's office so a nurse can remove it. With a big multi-day snowstorm on the horizon, and with that office being closed over the weekend, that could be delayed a bit.

I've got an appointment to see Dr. Alexander Hillel, a Johns Hopkins laryngologist, in early February, and to have a follow-up visit with Dr. Mady a few days after that.

I didn't even know there was such a thing as a laryngologist until now. Dr. Mady is an otolaryngologist (what they used to call an ear, nose and throat surgeon), and Dr. Hillel is even more specialized than that. The Johns Hopkins Medicine website says he focuses on "the medical and surgical management of patients who have scar tissue blocking their larynx and/or trachea, a condition called laryngotracheal stenosis." There's going to be a three-way conversation among those two specialists and Dr. Douglas Ball, my endocrinologist, about interventions to prevent the further spread of thyroid cancer, while preserving what's left of my ability to speak.

Before I was discharged from the hospital, Dr. Mady stopped by my room to share a post-game analysis. She told me she removed three small thyroid cancer tumors, including the one that evidently crushed my recurrent laryngeal nerve -- the tiny nerve that controls my paralyzed vocal cord. She wasn't able to get to all the thyroid-cancer tissue because the most troublesome tumor was located right up against the larynx (the "voicebox" that contains the vocal cords), not far from the trachea (windpipe). She's not sure whether the thyroid cancer has actually invaded either of those vital structures, but she couldn't remove any marginal tissue for biopsy, to rule that out.

It remains to be seen whether the damaged nerve can recover any of its function. At the moment, my voice is a little worse than it was pre-surgery. It's got a whispery quality, as before, but now I have the sensation that, after speaking a few words, I'm running out of air. I'm not actually running out of air (my breathing isn't any worse than before). It has to do with the way my vocal cords modify the airflow for speech. I've lost my "outdoor voice," the ability to project -- ironic, for someone like myself who used to teach public speaking to seminary students.

It's looking more and more like my decision to focus my professional efforts on writing -- sharing preaching material with colleagues on my new Substack, Curated Sermon Illustrations -- has been the right call. (Does that make me a holy ghostwriter?)

Possible future medical interventions, Dr. Mady tells me, include (1) an injection of collagen or similar material to bulk up my paralyzed vocal cord so it can mirror the vibrations of my healthy vocal cord, (2) targeted radiation therapy, (3) a possible repeat of the radioactive iodine pill I swallowed back in 2011, not long after my thyroid was removed, or (4) a relatively new chemotherapy medication. Speech therapy may also be worth a try.

But at the moment, job one is recovery from surgery, which starts with waiting out the imminent snowmageddon. I've been binge-watching old episodes of The West Wing on Netflix and wishing Martin Sheen could really be President.

January 16, 2026 - Surgery: What's Ahead

Yesterday Claire and I spoke via teleconference with Dr. Leila Mady, who’s going to perform my neck surgery at the main Johns Hopkins Hospital on January 21. Her answers to my questions were reassuring and to the point.

I asked if my incision would be the same size and in the same location as my previous two neck surgeries (my 2011 total thyroidectomy and my 2018 neck dissection with lymph node removal). Yes, her aim is to trace the same incision line as the previous surgeries — although, if she encounters a lot of scar tissue, that may not be possible.

The new incision will likely be smaller and more central in location — so the best case scenario is that it will follow part of the existing scar line and will require no surgical drains (as my neck dissection surgery did, which was what kept me in the hospital for several days afterwards).

I asked about pathology — whether there would be on-the-spot analysis of tissue samples or whether I would have to wait for results. The answer to that one is “both.” A pathologist will examine a “frozen section” under a microscope while I’m still on the operating table. The pathologist won’t be in the operating room, but will be nearby — two floors removed, in the same building on the sprawling hospital campus. Additional tissue samples will be subject to a more detailed analysis. Those results will take a week or more to come back.

Will Dr. Mady remove any marginal tissue, beyond the tumor itself? That depends on what she finds, and what the frozen-section pathology test reveals. She explained that her goal is to get all the thyroid cancer tissue she can find, but this tumor is located right up against the larynx. There’s not much she can do to remove marginal tissue on that side, for fear of damaging the larynx.

How long will the surgery last? Two to three hours, most likely — which includes the entire time I’ll be in the operating room, but excludes recovery-room time.

How long will it take for me to recover? Due to my respiratory issues, I’ll probably stay in the hospital overnight, but if all is well the next day, I’ll be able to go home then. My recovery will continue at home for a couple weeks after that, with a prohibition on lifting anything heavier than five pounds.

I asked if I could expect to regain any of the vocal capacity I’ve lost (currently I have a laryngitis-like hoarseness that prevents me from doing much public speaking). Dr. Mady was a little more encouraging than she was the first time I asked her that question. There’s no way to tell until afterwards if my voice quality will improve, she explained. If the tumor comes out easily, it may be that the nerve that controls my vocal cord can be preserved. In that case, it’s possible I could eventually see some improved speaking ability.

I also learned there’s another treatment that could improve my speaking. After I’m fully recovered from the surgery, I could undergo a procedure called vocal fold injection augmentation (“vocal fold” is another word for vocal cord). In that procedure, Dr. Mady would insert a needle into my neck, under local anesthesia, to bulk up the paralyzed vocal cord with a filler substance (fat, collagen or something similar). During that procedure, she would keep an eye on the vocal cord through a special scope, so she can precisely guide the needle. The added bulk would reposition the affected vocal cord so it’s closer to the middle of the voice box. There it could pick up some vibrations from the healthy vocal cord, improving speech quality.

So that’s the road ahead. I’m feeling pretty good about it (there’s something to be said for being an operating-room veteran). There’s no question but that the tumor must come out, to avoid further damage to other structures in my neck, like the larynx or trachea. I know that post-surgery improvement in speaking ability after this kind of surgery is uncommon but not unheard of. I’m not counting on any improvement, but if that should happen, I’ll rejoice.