Tuesday, October 21, 2014

Staying Positive

It is not difficult to figure out when your doctor is concerned simply by the way they ask their questions.

"So how long have you been hoarse?"

"This has never caused you any trouble before?"

"You can take a picture of this but you might not want to share it with your fiance since it might frighten her."

"I am surprised that you can talk at all."

"I don't know how you are able to run so fast with how much water (or lack of) that you drink."

This morning was my follow up visit with the ENT specialist to take pictures and video of my vocal cords.  The purpose was to assess the situation and develop a plan for surgery and recovery.  In other words, they needed to "see" how bad things really were.  The procedure started with a discussion so I knew what to expect and then they numbed my throat so I wouldn't gag.  The Doctor then held my tongue while playing a camera at the back of my throat.  There was a light shining down my throat that captured the imagery.  We went through several exercises where I made different sounds so she could see how my vocal cords were working (or not working in this case.)  Then we looked at the playback and compared my vocal folds to both normal vocal folds and to those that have a variety of conditions, which included cancerous cells of smokers.

I am going to try to focus on the positives of this visit and treat the negatives as just facts of life.

  • I don't have 4 polyps on my vocal cords as was initially diagnosed.  I have seven.
  • When you speak, your vocal cords should come together.  My right vocal cord is not moving at all. 
  • There is one polyp that is at the base where the folds come together that is the worst. 
  • Generally the polyps do not look to be cancerous.
  • I may have to undergo two separate surgeries so they can repair one side at a time and allow healing in between.  They may be a month apart, which would prolong the recovery of my voice.
Because it actually makes me a little sick to my stomach to think about these images, I have just linked to them and not included them within the text.  If you really want to see what healthy vocal cords look like and what mine look like, you are on your own.

I asked that the Doctor just be honest with me and to stop asking leading questions.  If you are concerned, then say that you are concerned.  Don't hide anything or make transparent statements.

My primary concern is to be able to speak normally again.  For now the prognosis was that after surgery and voice rehabilitation, this is possible.  Rejoice.  That means in time, I will return to a normal quality of life.  Knowing this, I then move down the list of importance.  I was able to ask a lot of questions about recovery both in terms of work and running as secondary concerns.


  • Initially I was worried that I would have to take weeks to months off of running based on research.  The Doctor indicated that only activities that strain the vocal cords, like weight lifting, need to be avoided.  When running (or other high intensity cardio workouts) the vocal cords actually relax to allow air passage and do not come together.  The Doctor said that I could run the next day if I felt up to it.  I almost peed my pants in excitement.  I said that my coach would be very happy to hear this!  

  • As thought, the first week post surgery will involve no talking whatsoever.   The second week may be a few sentences throughout the day, limiting the amount that I speak.  Then there will be a plan moving forward to increase the amount I can speak to the point where after 6-8 weeks I should be back to normal.  That said, during intense speaking circumstances (like 8 hours a day for 3+ days that I would normally perform during a work conference) there may need to be an approach of speaking for 30 minutes, then hydrating and resting for 30 minutes.  Knowing that I may require multiple surgeries to repair my vocal folds, returning to my normal speaking regiment at work may be further down the road than initially planned.
While the cause is still unknown, they suspect that the development of the polyps is due to a combination of factors.  The leading factor is a gastroesophageal reflux, which is a hereditary issue for me.  There are additional factors that make that worse, which include poor hydration and eating late at night (and then laying flat where the acid has a chance to creep up into the throat and irritate the vocal cords).

The immediate action items are to address the potential causes.  This includes proper hydration, not eating so late at night (or as close to bed time), putting the head end of the bed on small risers to create an incline (which keeps the acid down).  

The confusing part of this whole ordeal is when the actual surgery will be.  I think that the next step is that I have ANOTHER visit with the Doctor (who will perform the surgery) to develop a plan.  I had thought that the surgery would  be next week.  Based on availability, they wanted to schedule the next consultation for November 6.  That is two weeks away.  Luckily the Doctor from today indicated to the scheduler that it had to happen before then.  So I am waiting on a call to find out when the next appointment will be.  She did mention that there will be LOTS of appointments, consultations, check ups, etc throughout the process.  

So the good news for today is that the polyps don't look cancerous, it should not impact running and I will return to the same quality of life after surgery and recovery.  Let's focus on that for now and take things one step at a time.