Yesterday Claire and I spoke via teleconference with Dr. Lelia 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.
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