Three Days Out from thyroplasty (vocal fold surgery)

Tuesday, May 31, at 5:30 am, my daughter and I were in line at the Surgical Pavilion at the University of Washington.  Check in went quickly but I was pretty tired  because when the nurse asked what kind of surgery I was going to have, I responded "thoracotomy" rather than "thyroplasty."   Sarah will never let me live that one down.  Sarah went with me to pre-op where I donned yet another flattering hospital gown.  The anesthesiologists came by to chat and install an iv line on the top of my left hand.  One of them told me an anesthesiologist joke:  How can you hide $100 from an anesthesiologist?  Hide it anywhere in the hospital after 3 pm.

At about 7:30 I was wheeled into surgery.  It was a room crammed full of monitors, machinery and all sorts of things.  I had somehow thought that surgeries were sterile, empty spaces.  Not so.  I was shifted over to a narrow surgical table and given a donut pillow for my head and a horizontal one under my knees.  They draped me for surgery, which consisted of dropping a shower curtain down from the ceiling and sticking it to my chin, so I could only see directly above me. Then they injected the anesthetics to numb my neck so they could cut me open.  Two residents did all the grunt work with the incision--they stood close to me to make sure that I could not move during the procedure. It was actually a nicer experience than had they used a straight jacket approach.

Several times I felt whatever it was that they were using to make the incision.  To me, it felt like my neck was being sawed with a rotating bendable, wire brush, so I hollered, and they gave me more good drugs.  I had to stay awake  during the entire procedure, because I had to vocalize so they could make the proper placement of an implant that was just the right size.  So what would happen is that they would put in the implant, have me say "eeee"  or count to five, or hum, and then take it out and work on adjusting the size and put it back in and work on positioning it.  Eventually Dr. Merati stepped in a fine tuned the size, shape and positioning and we were done.  The two residents sewed me back up, chatting about the number of weddings they were scheduled to attend this summer, which was a rather interesting experience to actually be the chopped liver at the time!

It turns out that the cartilage in the vocal fold area was extremely soft, making it difficult to size and adapt the implant.  There's a system out there that uses pre molded implants, five different sizes, and I had asked Dr. Merati about it before surgery.  So in the middle of my surgery he remarks to me, "This is why we can't use the Montgomery process." 

If you are really interested, you can see a thyroplasty surgery here.  My surgery lasted probably 2 1/2 hours, a bit longer than usual, because of the softened cartilage.  Dr. Merati told me in a phone call yesterday that my cartilage was the softest he had ever dealt with, and probably was a function of the radiesse injection a year and a half ago.  He sent a piece of the cartilage out for analysis but there was nothing unusual found from the sample. 

I spent the night in the hospital and was discharged before noon on Wednesday.  Went home and slept most of the day, so I could go to Sarah's medical society honorary dinner at the faculty club that night.  It was truly a wonderful experience because before each of the new members were given their certificates,  part of their nomination applications (which were written by faculty and peers) were read.  Each one of the new members was terribly impressive.  I was sitting next to the featured speaker, a pediatric cardiologist from Rochester, NY, and she murmured that she doubted she would have made it these days given the achievements that were noted.  Truly a humbling experience. 

Along the way, I dropped wearing a gauze bandage over the 3 inch incision--it was too rough.  So what if I look like Bride of Frankenstein with those ugly ass black stitches on the front of my neck?  Like my father used to say when I was in tears over a botched haircut, "At least I don't have to look at it."  Funny how I now rather enjoy that saying, when I used to hate it so much.  We'll see how many double takes I get at Sarah's graduation tomorrow.

Yesterday was supposed to be an infusion day--the ct scans showed the tumors either had not grown or were shrinking a small bit, but the clinical trial managers back east decided because of the thyroplasty surgery, that I had to wait for two weeks.  I hope that doesn't give the tumors a new lease on life, so to speak.

My current voice is really rough, but that's in part because of the swelling occasioned by the surgery.  I'm having a bit of a problem swallowing as well, which I also attribute to edema.  But the pain, which was significant the first day, has largely disappeared.  I'm  just glad I never got that thoracotomy (which is the removal of part of one's lung).

Surgery scheduled

I saw Dr. Merati, the ENT at UW who will be doing my surgery.  The doctors and staff at UW could not have been nicer and when I explained that I wanted to have the surgery before my daughter left for her residency on June 7, they spent the morning pulling out all the stops for me to make it happen.  So many, many thanks to them.  It is scheduled for May 31st. 

As always, there is some caution here.  Dr. Merati has done this surgery (the implant is called a 'thyroplasty') over 300 times and he is confident that it will improve my voice significantly.  However, my breathing problems are not a standard presentation--something is not making sense in my reporting of the significant  breathing difficulties I am having upon exertion because most of the video taken in last week's endoscopy, show the airway fairly unrestricted.  So Dr. Merati wants to include  a neck scan in my ct scans as well. One thing that could have happened is that the original Radiesse injection could have moved further down into the windpipe.  In that case, it would be a nasty surprise because it would entail further surgical procedures, so the ct scan should help to determine if that is a problem.  

Dr. Merati was also interested in the fact that at least a year before the cancer was diagnosed, I was having swallowing difficulties and he wants to pin that down a bit better before surgery.  So tomorrow at 9:30 am I am back at UW for a swallow test with Ginger.  This means no food or liquids (including water!) after midnight. I will have to call upon my early  first communion training in the Catholic Church to make it through this privation......

Pre anesthesia on Thursday and a meeting with the speech pathologist on Friday.  It's going to be a very busy week.  More later.