It’s time for an update.
On February 3, I went in to see Dr. Alexander Hillel at the Johns Hopkins Medicine Greenspring Campus — in Timonium, just north of the city — for the injection into my paralyzed left vocal cord. It was not the most pleasant procedure, to say the least. I was conscious the whole time, so I’d be able to move my vocal cords on command.
I was seated in something like a dentist’s chair. Dr. Hillel’s resident inserted the tiny camera, at the end of a fiber-optic tube, into my nostril and down into the back of my throat. Then, Dr. Hillel sprayed lidocaine anesthetic into my throat — bitter-tasting stuff that caused me to gag. (From what I’d read during some internet research I’d done a little earlier, I’d learned that the gagging is part of the procedure — that reflex spreads the lidocaine all over the vocal cords and surrounding tissues.)
After waiting a few moments for the anesthetic to do its numbing work, Dr. Hillel had me stick my tongue out. He grasped it firmly using a square of gauze and pulled it straight out. Holding my tongue in one hand and a special curved hypodermic needle in the other, and guided by the tiny camera, he asked me to say “eee-eee-eee” to close the vocal cords as much as possible. Then he injected the collagen-like material into my vocal cord in a matter of seconds.
The pain was well-controlled, and it was all over very quickly. (This is where you want a highly experienced doctor doing this procedure — I expect Dr. Hillel has done hundreds of them.)
The doctor asked me if I wanted to see a video replay. He showed me on a screen exactly what he’d seen as he performed the injection. I could see the needle penetrate my vocal cord, causing it to plump up before my very eyes.
Curing the paralysis was not the purpose of the procedure. That will only happen if the damaged nerve eventually recovers, which is anything but certain. The reason for plumping up the paralyzed vocal cord is to move its leading edge to the center of the voicebox, so the healthy vocal cord is able to touch it. It’s the opening and closing of the vocal cords, and their vibration in sync with one another, that causes speech.
It’s kind of like a pair of theater curtains in a traditional proscenium arch. The curtains open and close as a stagehand pulls on a rope. In the closed position, the two curtains meet neatly in the center. But if one of the curtains is damaged, and the pull-rope controlling it is stuck in the half-open position, the curtains can’t do their job.
An obvious solution would be to repair the jammed control mechanism (which is analogous to restoring the nerve controlling the vocal cord). But that’s easier said than done. The only other option, in this analogy, is to sew some more fabric onto the curtain’s leading edge, extending it to the center, so the functioning curtain can meet it.
After a few minutes of observation — to make sure my airway remained open — I was cleared for Claire to drive me back home. I was warned to expect a sore throat, once the anesthetic wore off, and to rest my voice for the next day or so.
The result is that I can now speak without the laryngitis-like breathiness I’ve had ever since my neck surgery. My voice still sounds kind of gravelly — but clearly the vocal cords are now meeting in the middle, because I can produce enough volume for someone to hear me from more than a few paces away.
This is considered a temporary solution. The body will absorb the filler material eventually, probably after a few months, and the breathy voice will return. We’ll reassess options at that time. Another temporary injection is a possibility, as is a permanent vocal cord implant — a more involved surgical procedure, done through a small incision in the neck rather than by going down the throat.
As I met Dr. Hillel that day, he drew my attention to a framed poster on the procedure-room wall, with photos of vocal cords in various medical scenarios. One of the photos depicted a single paralyzed vocal cord, my situation. The first photo of the display, though, was captioned, “Normal inspiration.”
For a preacher, “inspiration” has a different meaning, having to do with the presence of the Holy Spirit. The Greek word for “spirit” also means “breath” — so, in medical terms, normal inspiration has no theological significance. It simply means the air is moving through the vocal cords normally.
I’m glad to know I left that procedure-room more inspired than when I went in.
On Monday, Claire and I have a consultation with Dr. Mady, my surgeon. I'm expecting she'll interpret for us what the detailed pathology reports — which are now in — are saying. We may also discuss next steps for dealing with the thyroid cancer. Further watchful waiting is always a possibility, as is a repeat of the radioactive-iodine pill I last swallowed in 2011. Targeted radiation-beam therapy may also be in my future, assuming they can find something large enough to target.
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