Thursday, February 24, 2011

T+24: Back to the Grind

Recovering from surgery plus 11 hours of time difference from jet lag do not make for a good combination. I got through my first week back at my office, but am very tired. I’ve been sleeping 8 to 10 hours a night, and feel if I could take a nap during the day I would. A lot of this is jetlag, but it is important to rest too.

Fortunately, much of my work can be done by computer and e-mail. However, I have had meetings with colleagues, both in person and by phone. My voice is functional but still very low in volume and very breathy. I have to use much more breath to get out a sentence than I would with a normal voice, and this tends to make me get light headed.

Technically speaking, I only took two days off from work, one was the Monday I met with Dr. Berke, and the other was the Tuesday of the operation. The next eight days were the Chinese New Year holiday, then I worked remotely for a few days, then attended those conferences and am now back in Shanghai working. It’s been a bit much, and I would recommend taking it easier than I have for at least the first month.

Drinking is getting easier, but I still have to be careful with thin liquids or they’ll try to go down the wrong tube. It’s the same sensation that happens to all of us from time to time, it’s just that it happens a little more often now. I’d say before the procedure that it would maybe happen to me once every month or two, if even. Now it’s happening about once a day or two. It is getting easier though and I expect in another week or so I’ll be able to drink anything I want quickly and without worry. We’ll see.

Monday, February 21, 2011

T+20: Return to China

I’m finally back in Shanghai. In fact, I felt I was back in Shanghai the minute I boarded that China Eastern flight at JFK. People were pushing and shoving, talking loudly in the aisles while others around them were trying to sleep. And the lady across the aisle kept spitting into the vomit bag the whole flight – I was wondering if maybe she too recently had an SLAD/R operation and had excess phlegm that she needed to part with. They should outfit those planes with the suction devices I used at the hospital. Better yet, they should outfit all of China with them. But enough China bashing, I’m getting off topic and there are plenty of good things about China too.  (If you want to read more about China, and my tales as a reluctant expat in Shanghai, you can do so at:

Stepping aboard China Eastern is
like already being back in China
However, the guy who sat next to me on the flight wasn’t one of them. He spoke Mandarin with a funny accent that I had trouble understanding. And because of the airplane noise, he could barely understand me. Since he noticed that I had a watch, for the last 11 hours of the 15 hour flight, he asked me every 30 minutes how much longer until we land. It seemed that we would never land, but eventually we did. That was sort of a microcosm of what I’m going through now with my voice. It seems that the next several months will never pass. But, of course, they will. And just as sure as I’m back in Shanghai now, I will soon have a strong and spasm-free voice.

As an aside, I do speak a fair bit of Mandarin Chinese, and found that my spasmodic dysphonia was always worse when trying to speak this non-native language than it was when speaking English.

It’s been a long journey, in many respects. In retrospect it wasn’t that bad, but I’m relieved that the hardest part is behind me. Now all I have to do is wait and be patient, which is not easy, because I’m not a patient person.

In one regard, it’s easier to be voiceless in China than in the US. I can just point to things in shops and they’ll just assume that I'm a dumb foreigner that doesn't speak Chinese instead of assuming that I just don’t speak.

Friday, February 18, 2011

T+17: Goodbye Thick-It

Baltimore was more of the same – more colleagues that I hadn’t seen in a long time. More of the “I feel better than I sound” and the Godfather imitation lines. Now I’m back in my hometown in New York. Took Amtrak last night. Ordered the ticket by starting off with, “Sorry I lost my voice.” The Amtrak agent said, “I’m listening up.” This is easier than I thought it would be.

I jettisoned a 30 oz unopened
can of Thick-It in my hotel room
in Baltimore.

I jettisoned the unopened Thick-It in Baltimore as I don’t need it anymore and I’m traveling alone and with much more luggage than I normally travel with. I also jettisoned my Scar Guard. I figured I would try using it to help protect my scar, but it gets flaky and shouldn’t be used in hirsute areas, so I decided it wouldn’t be helpful.

Tuesday, February 15, 2011

T+14: Next Stop Baltimore

It’s now two weeks since the operation, and I’m doing fine. For me at least, the first two weeks weren’t “highly unpleasant.” The first day or two were “somewhat unpleasant” with the rest being what I would term “neither pleasant nor unpleasant.” I started to drink liquids without the Thick-It. I have to be careful, but I’m getting them down. I’m doing fine at the conference because I’m only listening. Often at these conferences I speak. With spasmodic dysphonia that was always a stressful challenge. Now it’s impossible. But I’m looking forward to speaking again. Think I’ll be a great speaker when I eventually wind up with a non-spasming voice.

With a half dozen colleagues from Asia, we fly together to Baltimore, for the other conference that we all need to attend. I just bought a giant 30 oz can of Thick-It before I left Las Vegas that I’m dragging with me, but I don’t think I’ll even need to open it.

Saturday, February 12, 2011

T+12: The Godfather

Apart from having my relatives take me to too many loud restaurants, where I could only be heard by the person next to me, I spent my time relaxing and mostly doing nothing. I brought Thick-It to the restaurants in a plastic bag. I’m not sure if bringing a plastic bag of white powder into a public place is really a great idea, unless maybe you’re Charlie Sheen. My Aunt makes these really thick fruit smoothies for me, which are delicious, healthy and really easy to swallow.

The first 8 days after surgery was Chinese New Year so I didn’t need to be working. But I’ve been working remotely, keeping up on e-mail and staying in touch with the office the whole time. I took a nap in the afternoon each day – I seem to need to – and I’ve been sleeping at least 8 hours each night (which I also seem to need).

I have a little more voice than a week ago, though it is still very weak. I’ve been drinking a lot of smoothies, which are easy to get down. I can eat essentially anything now. My Steri-Strips are starting to half come off, and I have a beard now because I haven’t been shaving.

Clean shaven again. Bet you
can't see the scar!
Today with guidance from Dr. Jennifer Long, I used a washcloth and some soapy warm water to gently help the Steri-Strips ease off. I then lathered up and shaved. It’s a bit of a funny feeling shaving my neck because it’s still numb so it was slow going. I managed to shave over the incision – carefully and slowly but without any problems. It’s nice to be clean shaven again.

"Some day, and that day may never
come, I will call upon you to do a
service for me." 
I checked into the conference hotel, where I’m now bumping into 320 of my colleagues from the US that I haven’t seen in more than a year (I used to work in our New York office before moving to China). I warned many by email that I would have no voice, but for others, it’s still a surprise. My typical line is, “I feel better than I sound.” They ask if I have laryngitis, so I tell them I had surgery to fix my voice, then ask, “Doesn’t it sound great?” Then I tell them it will take a few months and say that my “Godfather voice” makes me more effective with customers. And then I do my best Marlon Brando as Godfather impression, “Some day, and that day may never come, I will call upon you to do a service for me.” Everyone laughs.

I’m in a loud, noisy place. I’m “yelling” and people can barely hear me, but everyone’s having a good time.


Monday, February 7, 2011

T+6: Driving to Las Vegas

Warm, beautiful days, with   
skiing just an hour outside of
LA. I really should move here.
Dad and I drive to Las Vegas. We stop half way at Burger King and I have an Angus Whopper or whatever the heck they call their premium burger. It’s really good, really disgusting and totally unhealthy all at the same time. I finish it off in no time and wash it down with a milkshake, which is really easy to drink, plenty thick without having to use Thick-It. Normally I can do a 5 hour drive easily on my own, but I got really tired, so Dad took over after 3 hours, while I had a nap.

We make a great father and son
team: I can't speak and he can't hear!
Since we’re on the way to stay with relatives in Las Vegas (I have a conference 6 days from now in Las Vegas, so decided to stay with relatives for a few days), we stopped to pick up a little gift. Dad’s ears had clogged up so he was having trouble listening to my non-voice. The guy behind the counter didn’t know what to make of us, so I said, “We make a great team – I can’t speak and he can’t hear.” That led to laughs all around.

One thing that will help you get through this period is to have a good sense of humor about it. The good news is that in a few months, I should (hopefully) be permanently relieved from the symptoms of spasmodic dysphonia. The bad news is that my voice is now worse than it’s ever been. But in a way, that’s okay. People understand surgery, and my voice is obviously not functioning. People don’t understand spasmodic dysphonia, and it was stressful to continually try to “hide” the problem.

Friday, February 4, 2011

T+3: Discharged

I had breakfast, showered up again, had my last antibiotic by IV and was about to leave when lunch arrived, so I had lunch. The nurse was doing a great job of yelling at the catering staff to bring me 10 packets of Thick-It with each meal instead of just three. I’ve been managing to eat with less Thick-It so I managed to build up a surplus of Thick-It packets.
Back at Tiverton with
Steri-Strips over the incision
They finally removed the IV from my hand, which felt great. I changed into my street clothes and was taken in a wheelchair (regulations) to the pharmacy (which is in the same building in the basement) to pickup my antibiotic, Prednisone steroid, Colace, Percocet pain killer and Nexium for reflux (I’ve never had reflux but it’s a precaution to protect the surgical site). Then they wheeled me to the front door and, together with Dad, we walked back to Tiverton House (about a 10 minute walk). There’s a shuttle or you can also take a cab, but it was a nice day and I felt up to it.

I went across the street to Ralph’s and stocked up on Yoplait strawberry pudding which is really easy to eat. I was also told that Ralph’s had “great chicken dinners” to go so Dad, Craig and I went over to check them out, and ate it at the Tiverton house lounge. “Great” was probably an overstatement, but it was much better than that mush I was eating in the hospital, and was my first real meal since the surgery. I can now eat just about anything as long as I chew it fully and swallow carefully. For beverages I still need the Thick-It.

I’m taking my medicine by opening up the capsules and mixing them into the Yoplait yogurt. In general, this is not an advisable technique since with some medicines this could result in a concentrated dosage. But I’m a little freaked out about swallowing capsules whole, and for the antibiotic and Nexium capsules, this method is works just fine. The Prednisone is in small tablet form and poses no problem when I eat it with yogurt. I don’t seem to need and thus don’t take any of the Colace or the Percocet.

It feels good to be out of the hospital. I don’t have much voice, but it’s more than I expected. If it’s quiet, people understand me. My wife and kids understand me by phone or Skype. If I need to talk to someone briefly in public, I just say, “Sorry I lost my voice”. They assume I have laryngitis, and it’s no problem.

I bought several boxes of tissue to deal with the phlegm, but they went unopened, as the phlegm has largely subsided.

Thursday, February 3, 2011

T+2: Neck Numbness

Dr. Berke and Dr. Long came to check on me in the morning. Doing fine – I have no pain and I’m getting the hang of eating. With Thick-It I can now polish off my meals in about half the time it took the day before. My voice is about the same, maybe ever so slightly better. I’m walking the halls quite a bit. 

The gauze around my neck came off to reveal Steri-Strips over the incision line (about 4 or 5 inches long just below my Adam’s apple), but still in the area where I shave. I noticed that my neck is quite numb from above the incision line to just below my chin. This is normal and will go away in a few months.

I probably could have been discharged on this day (and another guy who had the operation on the same day was discharged today), but I found the hospital to be comfortable, and a bit nicer than Tiverton House, so decided to hang out. (Don’t get me wrong – Tiverton House is a decent place to stay, but since I now live in China, I have grown accustomed to five star hotels for about $120/night, so Tiverton House at about the same price with its outdated d├ęcor and 1990s-style floral print bedspreads wasn’t beckoning me to return immediately.) So I stayed one more night in the hospital.

The IV in my hand is starting to bother me a little, but I’m not eager to start taking medication orally, so I’ll stay on IV for one more day and get my medication that way.

Wednesday, February 2, 2011

T+1: Hello Thick-It

That’s grape juice on my spoon. I went
a little overboard with the Thick-It!
They brought me breakfast, consisting of clear liquids: chicken soup, grape juice and tea. I added Thick-It to everything. Note that they’re quite stingy with the Thick-It packets at the hospital so I had to keep ordering more. They would bring me 3 packets per meal when I needed about 10. Word to the wise: have someone sneak your own can of Thick-It into the hospital just in case. At first it was a bit tricky to swallow but I managed to get through breakfast. Dr. Berke stopped by and showed me a few tricks to help swallow, which helped. Lunch and dinner (with similar “cuisine”) got a bit easier. Definitely can’t drink fluids, so the Thick-It is important.

Compression bandage already
removed, just gauze now.
The residents came in and removed my compression bandage and replaced it with a large piece of gauze wrapped around my neck. It’s not uncomfortable.  With the help of a nurse, I walked around quite a bit on the first day. My voice is about the same as day 1: weak and croaky, and the croakiness is more pronounced if I have a little fluid/phlegm in my throat. I had a headache at one point, but no pain at the point of surgery.

I was transferred to a private room finally. The private rooms at UCLA Medical Center are quite nice, and feature both a couch and a reclining chair for family or friends that want to visit. There are no visiting hours at UCLA Medical Center; family and friends are welcome around the clock. I got a little more sleep the second night, but still using the suction, and/or tissues to deal with the phlegm. They gave me some liquid Colace (stool softener -- typical after general anesthesia) which I mixed into some thickened water – it tasted terrible.

I read on Scott Adam's blog (he’s the Dilbert creator that had the same operation a while back) that the first two weeks would be “highly unpleasant.” I found the first day to be somewhat unpleasant, certainly not “highly unpleasant.” In fact, the most unpleasant thing was eating that horrible tasting Colace mixture – the other stuff wasn’t all that bad, maybe just because I was expecting it to be worse.

Tuesday, February 1, 2011

T-0: The Big Day

Pre-Op: Arrived at the hospital at 7:30am for the 10am procedure. Something I had read said leave everything in the hotel, so I complied and left my insurance card there. You should definitely leave rings, watches and other valuables at home or at your hotel, but definitely bring your ID (driver’s license) and insurance card. After some paperwork, I was shown to the pre-op area where I changed into a hospital gown and they prepared an IV on the back of my left hand. So far everyone has been friendly, polite and professional.

Operation: There was another SLAD-R spasmodic dysphonia surgery procedure scheduled before mine, but Dr. Berke had another procedure that morning before the first SLAD-R procedure, so I finally was headed toward the operating room at about 2pm. I was getting really hungry by that time as I had been fasting since my “Last Supper.” The last thing I remember is being wheeled down the hall, and talking to the anesthesia team. I recall telling them, “I feel great but this anesthesia stuff isn’t having any effect on me at all.”

Post-Op: I woke up about five hours later at about 7pm in the recovery room, and heard that everything went well. I’m happy and relieved to have the operation behind me. I have a tight compression bandage around my neck, but it’s comfortable and there’s no pain. I had a very slight, weak and at times croaky voice after the operation. I had expected that I would only have a whisper after the operation, so I am pleasantly surprised to find that I have a bit more than that. I seem to have a lot of phlegm and I’m periodically using a suction device (similar to what they use at the dentist’s office) to remove it from my mouth, as it’s kind of hard to swallow it. I didn’t eat or drink after the operation on this day but was no longer hungry, I guess due to the IV. Private rooms were in short supply so they transferred me to an “observation room” for the first night – as far as I knew, it was the private room and was fine with it. It was a bit hard to sleep because I kept using the suction to get rid of the phlegm.