Happiness is just outside my window
Would it crash blowing 80-miles an hour?
Or is happiness a little more like knocking
On your door, and you just let it in?
Happiness feels a lot like sorrow
Let it be, you can’t make it come or go
But you are gone- not for good but for now
Gone for now feels a lot like gone for good
Happiness is a firecracker sitting on my headboard
Happiness was never mine to hold
Careful child, light the fuse and get away
‘Cause happiness throws a shower of sparks
Happiness damn near destroys you
Breaks your faith to pieces on the floor
So you tell yourself, that’s enough for now
Happiness has a violent roar
Happiness is like the old man told me
Look for it, but you’ll never find it all
Let it go, live your life and leave it
Then one day, wake up and she’ll be home
Home, home, home
-Happiness, The Fray
Today was a good day. My appointment with Dr. Albert Merati was today. He’s the man that’s going to give me a voice again. He’s going to be the man to give me the ability to talk when I want to. He’s going to be the man to help me be heard again.
This makes me happy. More than you may ever know. You simply don’t know what it’s like to be without your voice until it’s been MIA for over 8 months. I may never have the same voice that I once had, but I WILL have a voice that can be heard. For that, I am thankful.
Got to UW Medical Center around 12:30, saw the big sign on the corner that says, “#1 Hospital in the State!” Wow. I’m glad to be here! Got checked in, signed some paperwork, and waited, and waited, and waited. My appointment was for 1pm. I think I was finally pulled in around 1:30 or so. Candace took my weight, down another 9 pounds. I think I’m getting excited about all this weight loss. I’m going to set a goal to lose at least 100 pounds before Nov. 29th. Anyway, we go into the exam room, takes my blood pressure, which I wasn’t terribly happy with, but it might’ve been because it was my first time there and didn’t really know what to expect. I tell her my story and about how I was with Group Health previously, she said, “oh”. In a tone that was like I’m sorry you had to go through that. I then told her my surgery was at Virginia Mason though and that seemed to have gotten her approval. lol. I think if you’ve never really seen any other doctors on a semi-regular basis except for those at Group Health, you don’t really get it why everyone says that Group Health isn’t that good. As far as I was aware they were pretty good to me. Then you have the ability to go to other doctors and hospitals and you realize that it just might be true.
So Candace leaves and Dr. Merati pops in to say hello and that he’s running late and has another patient ahead of me, I said no worries! About 10-15 minutes later, a nurse/student comes in and I go through my story over the last 8 months, telling her what my problems are, what I’ve been through, why I’m there, etc. I think I covered everything with her. She eventually leaves and I sit there for another 10-15 minutes and in comes a Speech Therapist, Jane, I think her name was. Maybe it was Jan? I dunno now. She goes through a bit more information about my voice and what’s happened with it since my surgery. She puts me into the exam chair and sprays some Affrin in my nose, followed by some Lidocaine. I’m not sure if it was because my mouth was fairly dry from all the talking at this point or not, but I don’t remember Lidocaine ever tasting this bad. Blech. She leaves, and I sit waiting for another 10 minutes. I’m getting tired of waiting at this point. I’m thinking about the money I’m losing while I’m not at work…
Dr. Merati appears again! Since this is a teaching hospital he brings in the nurse from earlier, as well as a lady from Turkey, and another lady, as well as Jan the speech therapist. I don’t remember the nurse’s name or the other two ladies. Oh well! They seemed nice enough, except for one of them that shook my hand and hers was really wet. I think it’s kind of cool to be going to a hospital that is teaching people that are interested in doing this for a living. In my mind, I’m helping them, while they help me. Awesome.
Alright, now we’re in business, I tell the doctor briefly about what I’ve been through, who did my surgery, who I was seeing at Group Health. He says Dr. Bayles from Virginia Mason is a friend of his. I told him how much I appreciated thee excellent work he did, and that it was a 6 hour surgery, Dr. Merati was a bit blown away to hear this. He said he’s also aware of how good of a surgeon Dr. Bayles is. I told him that Dr. Short had me scheduled for a Medialization Thyroplasty today but with the change of insurance and employers it had to be canceled. He mentions a different surgery that would repair the nerve. I said, “What? I’ve never heard about this!” He said, “we’ll talk about it in a it.” In my mind, I’m pretty excited about this option, and wondering why it was never brought up to me before. Anyway, the nurse then starts the laryngoscopy and sticks the scope in my left nostril, I’ve had this done so many times, it’s old hat. lol.
Jan has me start by making an E sound for as long as I can, hum the birthday song, a couple different phrases, a higher pitch E sound for as long as I can hold it. Which was about 8 seconds, not very long… All the while they’re looking at the monitor to see what my vocal folds and other areas around them are doing while I’m making these sounds. They eventually pull the scope out and we start talking about what they were seeing. He mentions that the right vocal fold is shot, which we all knew already. He also mentions about something being flaccid in there., I wish I could remember what it was called! I asked if that was a good or bad thing. He said it’s not a good thing. Essentially, because the muscle on the right side of my throat isn’t doing anything it’s kind of pulling away from the throat which causes what he called a “lagoon” for things to fall into. You’ll see this in a picture that I’ll post at the end. He then tells me that he’s really glad I didn’t get the implant done today as there’s still material from the injection I had several months ago in the vocal fold. If I had the implant surgery today, the size of the implant would’ve been used based on the way my vocal folds are now. Eventually, that material would dissolve like the rest of it has and I’d likely be back to where I am now to an certain extent. We talk some more about the findings, then he leaves with Jan and the lady from Turkey and the Wet Hand lady. The nurse then shows me the video from the scope and talks me through what they were seeing and points out the “lagoon” and the material in the vocal fold. I’m absolutely fascinated by this. She eventually leaves the room and I grab a picture of the monitor, the one you’ll see later.
Dr. Merati and the nurse come back in. We discuss the implant surgery, and then the NEW surgery option! Laryngeal Reinnervation. This is where he’ll take a chunk of the nerve that is unnecessary for one of the muscles in my shoulder and then splice it into the laryngeal nerve which is the nerve that helps control your vocal cords. I’m so intrigued by this option. He tells me that it doesn’t completely fix the vocal cord paralysis but it will move it closer to midline like the implant would and help with the muscle that’s flaccid. He says it’s not a common surgery and does about 30 implants a year while doing about 4 of the nerve surgery. Vocal cord paralysis is very rare, so that’s one reason why he doesn’t do that many surgeries for it. He tells me that he needs to read my surgery report and discuss things with Dr. Bayles before he tells me that this is definitely an option for me. As there might be other nerve damage or the laryngeal nerve might not be repairable at all. He tells me that the reinnervation surgery would likely be more comfortable for me as they’ll put me completely under for the surgery and will likely spend the night in the hospital, where as if I were to have the implant surgery I’d be slightly awake for the whole thing and go home the same day. That, to me just sounds uncomfortable and slightly scary. He asks me about the cancer and if it’s gone or not, I said all the numbers and scans so far would say it is gone and that I have a PET scan coming up next Monday. He said, “Good, let’s keep it that way!” He told me that I could have the reinnervation surgery anytime if I’m able to do it, whereas the implant surgery would have to wait 2-3 more months because of the remaining injection material.
He goes on to tell me that recovery from the reinnervation surgery will likely take about a year for the laryngeal nerve to “turn on”. He tells me that nerves are like a bundle of wires in a phone cord or a cars wiring, it contains a sort of blue wire, red wire, white wire, yellow wire, etc. The nerve that goes to my muscle doesn’t have the exactly the same wiring which is why it doesn’t completely fix the paralysis, but it does help the situation at hand, but it takes the body a long time to connect the dots between the existing nerve and the “new” nerve. Again, I’m absolutely fascinated with hearing this! To help with the vocal cord in the meantime while the nerve is doing it’s thing they’ll inject some more material into the vocal fold during the surgery which will dissolve over time as expected, and usually by the time it does the nerve should be “turned on”. I’m excited! I then ask him, without looking at the report and talking to Dr. Bayles, what would you recommend I do? He asked how old I was, he says due to my age, I should do the reinnervation. The implant is a foreign piece of silicone, which doesn’t age along with your body, so it might not be as effective 10-20 years down the road as the throat ages and does it’s natural thing. Whereas the nerve would be a natural way of doing it and would age along with everything else. Again, knowing this is an opportunity for me and knowing what some of the downfalls are of the implant is amazing to me. However, one of the benefits of the implant is instant gratification. Good things come to those that wait though. 🙂
I think it’s really a blessing that I was forced to leave Group Health. You don’t really realize it when it’s really the only hospital you have any significant experience with until you’re able to see what it’s like elsewhere. I’ve learned some things and given other options that I didn’t know existed as well as learned a lot about what’s going on in my throat! I’ve got a follow-up with Dr. Merati in 2 months, but it’s possible I’ll be seeing him again sooner than that. I look forward to hearing what he has to say after reading about my surgery and what Dr. Bayles has to say. I think it’s awesome that they know each other!
When I got back to work I did a quick search for Laryngeal Reinnervation surgery and came upon this article
which turned out to include information from Dr. Merati. Awesome.
UWTV also has a 28 minute video
on their website where Dr. Merati talks about different ways of fixing patients voice problems along with Dr. Hillel (whom my former ENT, Dr. Short had recommended I see for the Thyroplasty). It’s a good watch and helps to provide some insight if you have the time.
with where things are going, I’m excited to hear of other options on the table. I have a sense of happiness
along with comfort knowing I’m in excellent hands. I look forward to hearing from Dr. Merati again! I can’t wait to hear a resemblance of my old voice again. I can’t wait to call my 96 year-old Grandpa and talk to him on the phone again. That day will come and it is gonna be awesome.
1. This is the “lagoon” that he spoke of. Notice it isn’t like that on the opposite side.
2. This is the Right Vocal Cord. The yellowish color is the remaining material from the previous injections. Over time this will dissolve.