Medical update May 16, 2011

A few weeks ago, I noticed that when I was falling asleep, I would whistle.  I, of course, assumed it was a wheezing in the lungs,  In addition, my voice quality took a turn for the worse and then I started becoming breathless upon even minor exertion.  So, based on my complaints, two weeks were spent with first Sarah checking my lungs with her stethoscope and pronouncing them fine and then Jeanette, the physician's assistant in the clinical trial, doing the same.  For a while I though I was losing my mind, or becoming a hypochondriac, but Friday morning, May 6,  I woke up and my first thought was, "It's the vocal cords!"  Which meant either that the Radiesse injection that had been introduced to my left vocal cord  back in January of 2010 had  dissolved, or that my right vocal cord was becoming paralysed because the tumor was growing.  You can guess which one I was hoping for.

I emailed Dr. Martins, my oncologist, and he set up an appointment with otolaryngologist, Dr. Merati at Univ. of Washington.  Unfortunately Dr. Merati's first free day was May 27.  But of course, I whined to Dr. Martins and as a result, I was seen today by Dr. Weissbrodt, an ENT fellow who works with Dr. Merati at the University of WA.  We had a great visit and he did an endoscopy, which is only second to a colonoscopy in my pantheon of least favorite medical procedures.  However, rather than the antiquated endoscope that Group Health still uses, this one was much more advanced--it took and saved pictures to a computer file, so I could look at them with Dr. Weissbrodt after the procedure had, thankfully, ended.

If you may recall, in an endoscopy, the nose is temporarily anesthetized and a narrow, long tube, with a camera at the tip is shoved guided down the nasal passage. Then I was requested to say a long "eee" followed by counting from 1-10 and saying some phrases that engaged the vocal cords.  The final stretch was breathing deeply using my mouth.  That was the 'aha' moment for Dr. Weissbrodt, because when I did it, this is what happened:

Yes, indeed, I am showing you my very own vocal cords, except you can't see them because the muscle that is supposed to power them on the left is completely drooping down, and, in fact, covering my vocal cords AND my windpipe!  My tongue is the big whitish thing at the bottom of the photo, so you can orient yourself.  No wonder I was having spasms when I climbed the hill on Madison from 3rd to 5th at noon!  I could not breathe because of this drooper. 

Here is what normal vocal cords and their musculature look like per Gray's Anatomy without the tongue, which would be normally found at the bottom of this picture covering  the epiglottis:

You can see the vocal cords in the above illustration because both sides of the muscle are toned and upright.  In my case, the  knobby part of the arch on the right (my left) no longer has any tone and as a result is lying down, blocking the aperture of the vocal cords (the ovoid hole in the illustration--you can't see much of it in my photo above)

The first illustration seems upside down as to the words, but that is so the view corresponds to the my color photograph.  The second illustration contains the words right side up, so it is the left corniculate and cuneiform cartilage and the aryepiglottic  fold that are hanging over and blocking the view of the vocal cords and, consequently impeding my breathing.  

According to Dr. Weissbrodt, the loss of the injection into my paralyzed vocal cord can be taken care of in a surgical procedure where they incise my throat and go in and insert a small block to plump out my paralyzed vocal cord again.  With one stitch they can tie up my  drooping cartilage and fold, so it won't flop over and keep me from breathing upon exertion.  It's a one day procedure that is done only under local anesthetic because I have to make noises to help them position the block but I have to stay a night in the hospital because there will be a drain installed.  I've requested that as long as they are going in below my chin, that they pull that up while they are at it.  I will next ask if they can make sure that I will be a coloratura soprano when they get done. 

Hopefully, we can schedule this before my daughter graduates from medical school on June 4 (with academic honors mind you!) and leaves me for a 4 year residency at the University of MN, where she and her brother, Seth, will be sharing an apartment.  Can't wait to visit them!!