Wednesday, August 18, 2010

Neurapraxia & Paresis, or Why I Still Can't Talk

Remember back to before I found Gumball, and I had to have neck surgery, and I was left horrifically disfigured (according to Rosie Perez), and then the doctor got concerned about my persistent hoarseness, and referred me to the ENT?

Well, I finally got the appointment with the ENT, and boy, did I have fun! A week before my appt, they sent me an eight-page history form to fill out, as if I was signing up to receive a lifetime of ENT care from this dude - I absolutely cannot believe the unbelievable lengths they went to to ask me all sorts of absolutely, positively, irrelevant questions, for someone being referred for a post-op complication. But I filled it out.

So then I get there, and they want my picture for their electronic medical record (this, right after they photocopied my driver's license to insure I wasn't committing insurance fraud). So I refused - which I'm guessing from the look on the clerk's face NO ONE has ever done before - but could she not see?: I am horrifically disfigured - just ask Rosie Perez!

So, after waiting 30 more minutes, they finally called me back, and demanded that I step on the scale - again, totally irrelevant to the reason of my visit. Then the tech starts going through the 8-page history with me, because poor girl has to enter it into the electronic medical record (EMR), and she doesn't understand any of the big words I used! So sorry, little untrained technician, that I called my hernia repair a "herniorrhapy", etc, etc - because this part took another 30 minutes. (And the ENT really didn't need to know about my hernia, or my hemorrhoids, or my hysterectomy. Good grief.)

So tech girl finally finishes, and tells me not to worry, because my surgeon refers "tons" of people to this ENT for this very problem. HOLD THE PHONE - he told me I was only the 3rd one in all his years of having performed the surgery to ever develop the problem in the first place, and now there are "tons"?!?!
So I gave her my MOST sarcastic voice, and said, "My, THAT'S reassuring."

Then the ENT arrives (with tech girl in tow), so I took that opportunity to ask about the tons of referrals he's allegedly receiving from my surgeon for this "unusual complication". And he repeated the stats from MY surgeon - that I was only one of three. I bet tech girl invites me to her next Christmas Party!

Then he reaches behind himself and grabs a brown bottle with a long nozzle on it, and rolls closer to me and starts to aim the bottle at me, when I pipe up and say, "You DO realize I'm allergic to that". For I knew it was lidocaine, which I am very much allergic to -so much that I had listed it as #1 of my allergies on page 6 of the 8-page history form. So he leans around me to where tech girl is scrolling through my EMR searching for the allergy portion, which she displays, and he stares at it like it was some lie I'd pulled out of my ass just to screw up his day. Then he started to interrogate me in this patronizing voice, trying to determine whether in fact I was truly allergic to lidocaine, or maybe just didn't like the taste of it, or what, exactly? Seriously - what do I gain by being allergic to the most commonly used topical anesthetic? But I gave all the correct answers (whew!), and he put the bottle down, and I told him that my other doctors dealt with this by using marcaine or carbocaine, usually.  He says he doesn't have anything except lidocaine.

So he whips out the laryngoscope (basically, just a much shorter version of a colonoscope), and tells me that when he was a resident, he had to perform this procedure on himself numerous times without anesthesia, and it really isn't that bad.

And he passes me a hand mirror, and shows me how to sit so that I can watch the whole thing on TV. Woo-hoo!

And he starts passing the scope up my nose and down my throat, and of course I'm coughing and gagging and tears are streaming out of my left eye, and he is assuring me that all this is normal, and giving me little instructions like "cough," "swallow," etc - in between all my coughing and gagging. And all the time, he is narrating this like it's the "It's a Small World After All" Ride at Disneyworld. "and here on the left you see your normal left vocal cord," etc.  And all the while he is calling out stuff for tech girl to enter into the EMR - sounded like a few big words, too - so no telling what really went in there.

But alas, while I have no vocal cord polyps or nodules, my right vocal cord is about 99% paralyzed. Not 100% - he saw a minute amount of movement. So the technical term for what I have is (extreme) right vocal cord paresis (weakness).

And this paresis is due to intra-operative damage to the right recurrent laryngeal nerve, probably during some cauterization of some bleeding during the surgery.

And then, having given the tour and determined the source of my problems, he removes the scope. And I choked out the words "you DO know I'm a physician, don't you?" Well - seems like in all those 8 pages of history, THAT never came up. So he says "No", and then asks what type of physician I am, and then asks if I have ever seen a laryngoscopy before (yes).

So then he proceeded to outline the 2 possible surgical repairs of this condition (neither of which would be considered until after the normal healing time has expired), and neither of which sounds like fun. In one, I have to go into the hospital for outpatient surgery, and they would pass the endotracheal tube down my throat, and I guess a laryngoscope, and visualize the cords, and then he would inject Restylane (the collagen-like substance that women (mostly) get injected into the wrinkles on their faces) into my poor paretic right vocal cord, thus plumping it up and allowing it to meet the left vocal cord in the midline, so that normal sounds can come out of my throat. There was no discussion of complications, or how often I would have to have this done (I know women who use Restylane have to keep getting the injections in order to keep the look they achieve with it). - no discussion, because it isn't time yet!

Option number 2 is also outpatient surgery - and had a really long name, but basically it involves going into my neck surgically from the front (he thinks he could use my horrific Rosie Perez scar, though, instead of making another horrific scar on my neck) and then inserting a piece of Gortex right next to my poor paretic right vocal cord, thus pushing it over to the midline. Permanently, I guess. Again, no discussion at this time, because I still have lots of healing time on the clock!

The technical term for my condition, in the ENT's professional opinion, is "neurapraxia," "an injury to a nerve that interrupts conduction causing temporary paralysis but not degeneration and that is followed by a complete and rapid recovery" ("rapid" being an extremely relative term). The recurrent laryngeal nerve, according to the ENT, regenerates at a maximum of 1 mm per day, and the damage is approximately 70-80 mm from my vocal cord, so it could be as few as 70 days (from the surgery) until it heals, or it could actually be up to twice as long as that, if I am a slow nerve regenerator. 70 days would be on Sept 2; but that is the best chance scenario. 160 days is December 1.  He wants to see me back for a repeat laryngoscopy (without anesthesia!) on September 13. But here's the deal, if I am still hoarse (even if I am somewhat better) on September 13, he will do the scope again (oh joy) and then tell me that I still have a bunch of healing time left - and set another re-scope date. So I am going to watch this thing, and if I am not 100% back to normal by September 13, I am going to reschedule the scope date again, and again, and again, until it is past December 1, and then he can take another look.

It was really a pretty traumatic procedure for me, and I'm sure he has bills to pay and all, but I cannot see what I personally have to gain from being scoped until the time is up. Plus it ain't free, even though I have insurance! And I will ask to forgo the mm by mm detail of my throat's anatomical structure on the next scope, which should make the procedure last about 25% of the total time it did this time.

1 comment:

PussDaddy said...

My you are really having a time huh? I am sorry to hear you are going thru all of this. Why is it called a Rosie Perez scar. Does she have one too? I have no idea why they ask this stuff over and over. Last time I told the person "You know what, no I'm not filling out that shit because it is on your damn computer because I have been coming to this facility for 13 years and I am sorry you are on another fucking floor and too lazy to click a mouse but you are going to have to click the damn thing because I am not filling out this redunant crap today." And they got on the computer and looked, lol.
Then I told the doctor who was was smiling his sarcastic little smile and speaking to me in baby talk because I was upset that if he didn't stop talking to me in that patroninzing little kid voice I was going to punch him in the face.
They had to seperate me and the doctor. Luckily I didn't need him anymore anyway.
I sure am sorry you are having all of these health issues. I am sorry you have such a scar. To people who love you it wont' matter tho.
I hope they get you fixed up and feeling better soon.