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.
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