The Snore Of Destiny Part Trois.

As I write this, I'm at a rather low ebb. 

A few weeks ago, as regular readers may recall, I underwent surgery on my throat to address an issue I was having with swallowing and choking - as well as an annoying snore. Throughout the course of investigation, it actually turned out to be a more serious issue than I had anticipated, involving the paralysis of one side of my vocal cords. You can recap on the short history here and here. 

The objective of the surgery was to create an area of scar tissue that would have the effect splinting my airway open so that it wouldn't flop inwards, particularly when I sleep and thus cause the snore. It was also going to address the problems I've been having with my swallowing which has, in a word, become scarily dysfunctional.

To cut a long story short, that surgery did not have the outcome we were hoping for. 

It didn't work. 

My swallowing remains dysfunctional and the snore wasn't neutralized. In fact, if anything, it's worse. 

I have tried to cajole myself along in the hope that it would all settle down, and once the healing process had run its course, all would be well. But it didn't turn out that way. 

So last week, after visiting my surgeon, I had to make a decision. 

I was presented with the option of returning to hospital and having a dual procedure that involves removing some of the tissue around my palate. This includes the uvula - that dangling, tear drop shaped piece of flesh that hangs down from the roof of the mouth and swings back and forth. The effect of this palatal flap surgery will be that it will open that section of the airway up and reduce amount of negative pressure that can be exerted on it when I sleep. Simply put, it won't vibrate and therefore I won't snore. 

The second part of the procedure is the trickier proposition. It involves going back to the area of my vocal cords that has been affected by the paralysed nerve supplying that region of my throat and removing the bone that anchors my right vocal cord. This is called the arytenoid bone. By removing it and applying the laser to that area of the throat, it will widen the airway as well as strengthen it by deliberately forming scar tissue. It will prevent food and fluid from entering that area of my airway that was sneaking in underneath the epiglottis. That's the flap of tissue that closes over my airway during swallowing and prevents food and fluid from falling into my airway. 

This is happening this week - this Friday.

The trade off?

My voice. 

I have to face the fact that this surgery will have a profound and permanent effect on my voice and my ability to speak. 

It has come to that because of the dysfunctional nerve that supplies my voice box. It won't recover from the viral neuritis that has affected it and so, what is being done now amounts to damage control. And I've chosen this route because - basically - I don't want to choke to death in my sleep because of some small fragments of food and fluid that has snuck into my airway.

I will require therapy afterwards to kinda retrain my throat and the muscles in it to adapt to this more extensive surgery. So I expect my recovery to be a lot more complicated.

But to sacrifice my speech...

Our voice is everything. It is a key part of who we are and without it, how are we to express ourselves?

I've been thinking a lot about this over the past week. Of course, expression and communication in this written or text form is so much a part of who I am & so I don't doubt that I will continue to express myself in this fashion. 

But, expression and communication is much more than simply words on a page. 

It's conversation. It's interaction with others. It's expressing ideas. It's singing shitty pop songs in a moment of abandon - either alone or in the presence of others. It's talking on the phone to loved ones far away.

It's reading stories to my children. 

I've been thinking about that one a lot. I remember a promise I may to my daughter recently that I would re-read to her The Guernsey Literary & Potato Peel Pie Society. I used to read it to her when she was first born as a way of getting her used to my voice. She always loved hearing me recount that.

What am I going to be without my voice?

I'm scared. 

...Friday.

DFA.

The Snore Of Destiny - Part Deux.

It's quite a thing to be travelling along, living your life and dealing with the mundane problems of life and then, suddenly, be forced into a sudden left turn that, literally, shakes shit up. 

So, remember that time when I was talking to you about a little problem I had with snoring? You know - when I'd resorted to a handful of "home remedies" in the hope that I could stop this throaty rumble that had people running from me as if I was the xenomorph from the Alien film series?

Well...it turns out that there is a reason for this snore - and it is one that I hadn't anticipated. At all.

I won't go into a long winded recap of the whole snore-fest. You can click through to read my original post and the rather screwy lengths I'd gone to try and stop it. 

After we returned from our family holiday on Kangaroo Island, I'd resolved to give this thing proper medical attention and I went to see my G.P. with the intention of nipping this thing in the bud right away. After examining me and determining that there was no obvious reason for me to suddenly have begun snoring, my GP and I decided to refer me to an ear, nose and throat surgeon. Because I'm *in the business*, as it were, I know a number of fine surgeons in this field. An appointment was duly made.

Upon visiting the ENT surgeon and having the somewhat wierd experience of a camera being threaded down the back of my throat right there in his rooms, a rather alarming discovery was made. It turns out that my right vocal cord is paralysed - specifically, the arytenoid cartilage that anchors the vocal cord to the  result is that during things like speech, breathing or the act of swallowing, the right side of my throat is collapsing inwards whenever the cords come together so that they don't close up properly.

image credit: Mayo Clinic.

In my discussions with both the GP and the ENT surgeon, a couple of things were happening in addition to the snoring that I'd kind of disregarded but were now, with the advent of all this, things that I should have paid more attention to. Over the past few months I'd noticed, on occasion, that whenever I engaged in exercise I would, after a while, find it difficult to breathe and in addition to that, my breathing had become quite noisy. I was producing a stridor. After exercise, I'd noticed that I had the feeling of a lump in my throat without any real explanation. It was uncomfortable but I'd gotten used to it and therefore dismissed it.

And, very occasionally, I'd noticed that I have struggled with swallowing - whereby I have actually choked on small morsels of food that would otherwise be considered innocuous. There have been a few instances of this that have garnered wierd stares and chuckles from my family but they didn't occur so often that we'd conisdered anything untoward about them. All these symptoms have gotten progressively worse in the last month or so and they've been harder to ignore.

So, on the day that I'm sitting in the surgeon's rooms and we're discussing a paralysed vocal cord, two things came up as causators for it - the first being a viral neuritis leading to an inflammation of the nerve that supplies the right side of my vocal cords. The cause for this is generally sheeted home to a viral infection which can be something as general as a flu. 

The other possibility was a lesion or tumour.

Alarm bells sounded in my head on that one as I recalled memories of my experience of the spinal cord tumour that disrupted so much of my adolesence. Whilst I'd been told that the chances of me having another tumour like the one I'd had in my spinal cord was remote, there was always a slight possibility there could be another schwanomma lurking around inside me. 

In light of this, it was decided that I should undergo two tests to bed down what we were dealing with - a sleep study to monitor the severity of my snore and its affect on my sleep and an MRI scan of my neck and chest to rule out the possibililty of a new tumour growing on the cranial nerve.

image credit: Auburn University.

If you've ever had an MRI, you'll know that it is, at best, a disconcerting experience. You are essentially placed inside a tunnel that isn't much wider than the average person from shoulder to shoulder. It is an uncomfortable and claustrophobic environment and moving inside the tunnel is not an option. Furthermore, a series of huge magnets revolve around you that create a noise unlike anything you've ever heard. It's loud and it's a little scary. 

For my scan, I had the additional *delight* of having my head and neck encased in a rather medieval cage, securing me in such a way that even subtle movements of my head were impossible. Scratching my nose was out of the question. For 45 minutes I was inside this machine, completely helpless and at the mercy of noise that would make Darth Vader quiver. 

The sleep study was a world away from that experience and I was able to complete it at home with a minimum of fuss. It's not really worth mentioning to be honest, but here's a nice picture.

The week long wait following the scan passed in a blur and I was pretty withdrawn for much of the time. The thought of possibly having a tumour - another tumour - was breath taking. Recalling those memories as a kid, going through serious surgery was unpleasant to say the least and it was all I could to keep myself from descending into panic.

Fortunately, the MRI was clear of any sign of a tumour. My relief at having dodged that bullet cannot be understated and I almost had an episode of urinary incontinence in the surgeon's rooms. The scan was able to visualize the defect in my vocal cord and noted the swelling caused by the snore and the general irritation of the tissues in my throat. The sleep study cearly showed that the snore accompanying my sleep state was significant though my overall sleep was rated - surprisingly - pretty decently.

So what's the next step?

Well, in a few weeks time, I will be admitted to hospital to have a more thorough study of my throat known as a nasoendoscopy. During that procedure, I'll be anesthetized and the surgeon will examine how the defect with my vocal cord causes my snoring. He also intends to examine my throat further down, to rule out any other causes or problems with my throat that might be contributing to all of this. The bigger part of the surgery, the part that I'm the most nervous about, will involve the surgeon applying a laser to an area of my throat adjacent to the vocal cord. He will, literally, burn it, creating an area of scarring that will, hopefully, prevent the vocal cord from collapsing in, causing the snore and the asymmetrical airflow over my cords that has caused so much trouble for me over the past few months. It will be a little painful and I may have some temporary difficulties with speech and swallowing but the snore will be gone and my wife will want to share the same bed with me again so that's gotta be a good thing right!???

This was a left turn I didn't expect to be taking and I certainly didn't expect that a snore would have a decidedly more complex root cause as mine does.

I get to be a patient. As a clinician - that's going to be a *fun* experience. 

You know what they say about nurses and doctors making the worst patients...

DFA.