Diabetes Self-Management Blog

Let me preface this week’s blog by letting you know this is another diabetes-free entry. The great thing about my Type 1 diabetes (yes, I did say that, “the great thing about my diabetes!”) in all of this thyroid cancer surgery stuff that’s been predominant in my life for the past few months is that in the past month, since I had my total thyroidectomy, I haven’t had any instances of high blood glucose. None. Twice that I can remember I saw my numbers dip into the 70’s, but I felt those coming on and was able to correct without worry.

I do have to say, however, that when you’re thyroidless and on a temporary thyroid supplement, those moments when you get some of the side effects of no thyroid can feel similar to lows, but I’ve been pretty good at differentiating. My thyroid hormone bodily screw-ups feel colder than my low blood glucoses. By that, I mean that there’s more of a chill in my legs and feet; it’s colder than the clamminess of a low blood glucose. Thank goodness for small favors, huh?

So onto the voicelessness of it all…

As I said, it’s been a month since my thyroidectomy, and I still don’t have a voice. I can produce some sound when I force a lot of air through my vocal cords, but to do so for more than a sentence or two exhausts me, and I can’t talk anywhere that has any ambient noise if I expect anyone to hear me. Needless to say, this has been first and foremost in my life since returning to the world two weeks ago (to work, to social situations, to attempting to navigate stores and clerks as a voiceless adult). Ask people who’ve been in public with me and they can corroborate.

Last Saturday I had a half-hour in which I thought my speech was returning because I was able to make a phone call to my mom and she could actually hear me. I was elated. But that elation was a short-lived; my assumption that my voice was returning was an overly optimistic pronunciation on my part. By the time Kathryn got home that afternoon, I didn’t really have anything — literally — for her to hear.

This morning we went to the University of Michigan’s Vocal Health Center to see laryngology and voice-disorder specialist Dr. Norm Hogikyan (pronounced “ho-gee-kin”) to find out more about what’s going on.

I’ll try to summarize…

After some tests and a laryngoscopy, Dr. Hogikyan said that my left vocal fold (or vocal cord) was weak, exhibiting paresis (partial paralysis); the right vocal fold was paralyzed. So, yes, during surgery, they did monitor the nerves, and while those nerves are grossly intact, they are nonetheless weakened.

Hogikyan says he’s optimistic, however, and believes that my voice will eventually fully recover. The kicker is that it’s difficult to predict when this recovery will be. It can take six months to a year for vocal fold paralysis/paresis recovery. The right vocal fold, with its complete paralysis, is very unpredictable.

There are several possible ways to approach treatment:

One way is to do EMG (electromyography), which would involve passing needles into the right vocal fold to get more information on the muscle, but because there’s partial paralysis in the left fold, he’d only want to perform EMG on the right fold; furthermore, at this point there’s no reason to do EMG, because the information learned wouldn’t change the treatment that he wants to do over the next three months or so.

That treatment: speech therapy and time. For the next three months I’m going to be visiting a speech therapist once a week to try and “better use the instrument I have” while the nerves heal. Speech therapy isn’t treatment, per se. It will not speed the healing process; it won’t help me to heal. But because it’s early for me in terms of being in the world of vocal fold paralysis, giving the nerves time is the best course. Time, I hope, will tell.

I have another visit in May with Dr. Hogikyan to see what progress the nerves/folds have made, if any, and then we’ll see about the EMG.

A third option is surgery. This would be something to talk about when we see where things are after six months to a year (if there’s little improvement). Well, there’s also injection of silicone; they do this into the vocal folds to increase their size to help them close better, or to lessen the gaps. If (if) there were to be surgery way down the line (and I hope it wouldn’t come to that), they’d reposition the paralyzed cord closer to the center so it forms a more full closure when I speak. This isn’t something the doctor would want to do while the left fold is still in paresis, however. No matter now; these options aren’t likely to be utilized (again, I hope that I’m correct in saying this).

For now, it’s speech therapy. Thankfully I really like the guy with whom I’ll be doing my speech therapy sessions. Marc (the speech therapist) told me this morning that some of the things he’ll ask me to say and some of the vocal exercises I’ll be asked to do during therapy will be some of the weirdest things I’ll ever do with my voice.

Know this (because I hear it a lot): I can “talk” now in my loud whispery-somesound way as much as I want and not hurt anything (except maybe your ears). I hear people say “well don’t try to talk” or “save your voice” daily. This is not hoarseness, not laryngitis, not any kind of “save your voice” malady. Unless people are simply sick of hearing me rasp-whisper, there’s no harm in my doing so, no damage I can do to my voice by talking. Of course, because I get winded easily by trying to speak louder than a whisper, I don’t talk very often. The doctor does encourage me to continue talking, because like any muscle, the vocal muscles would atrophy without use.

How am I doing with this news? I’m pretty depressed. But wait! When I say that, I don’t mean I’m in a depressive episode. I’m just quite blue about it. But my attitude is getting better all the time. I wasn’t expecting to leave the doctor’s office with my voice back to normal, but this six months to a year thing is, I admit, pretty disheartening, especially when you add to that the chance my vocal folds may never fully recover on their own (slight chance, but chances have within them the possibility of happening).

I guess I was hoping to hear that maybe I’d experience a return to normal by spring?

Hogikyan said that with vocal fold paralysis this type of prognosis is pretty standard. What he didn’t say, but what Kathryn and I know from reading about thyroidectomies as well as from our conversations with doctors and therapists, is the fact that a vocal cord paralysis this long after a thyroidectomy is not common. Oh, it was briefly talked about in all of the presurgical consultation and literature (and in the document I signed before they cut me open in which I agree there are risks), but an incidence like this, if I understand the Web surfing I’ve done in medical journals, is very uncommon.

I shall continue to remain myself, however, despite the occasional doldrums. I’m returning to my therapist tomorrow after some time off — my thinking the past month was that an hour of therapy when I can’t talk seemed pointless. But I’m going to try; otherwise it may be months before I get back into the therapist’s office with full voice.

My intention is to try to whisper my way through a session; I think that will help me bolster my emotional reserves, because I’m doing fine, but prevention against unforeseen sinks into darkerness (my word, sorry if it’s confusing) is always healthier than attempting to climb out.

I’m at the point lately where I’m rather amused with my lot in life, lovely as it is 99% of the time. Don’t worry about me or for me, because I’m more fortunate than most, despite everything you may read about what I’ve gone and continue to go through.

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