Results tagged “laryngitis”

Today my voice returned, after more than two months. Some tight scheduling in Coquitlam prevented a planned appointment here, so my dad, Air, and I drove to Surrey.

There, an ENT doctor injected one side of my vocal cords while his colleague manned the nose cam to view the process from the inside.

The result, so far, is a partial return of sound. My right cord is quite calcified, the doctor says, and may never firm up completely. So I have, for the moment, a voice whose pitch I can't control, but which might get better. It's louder, which helps my dad. It isn't whispery or raspy, which helps everyone else. It does the job.�We'll hear if it improves, which should be good for the relatively little time we all have left together.

My stupendously difficult climb from car to main floor in our house today tells me I won't be leaving in anything but a stretcher from now on—it was the hardest thing I've ever done. I'm now officially housebound, and even floor-bound.

I'm at the point with my cancer that the car has finally bumped down off the pavement and we're driving on gravel now. What I mean is, the end of the road is somewhere up ahead, not too far, and I'm not going back to smooth speedy travel, ever. To keep moving at a reasonable pace, I have to pay more attention to details, and a lot of stuff I previously took for granted requires effort—mine or someone else's. This has happened faster than I expected, but life often does.

Several doctors have helped me manage my symptoms, and the celiac block procedure I had last weeks seems to have helped with abdominal pain, for one thing. While my chest cough persists, it is not from fluid building up in my lungs. I am treating the cough, most often at night, with a drug that dries tissues out locally so I can more easily find a comfortable sleeping position. The Depends are doing their job too.

Both of my feet and lower legs are swollen, but that appears to be a regular consequence of my metabolism becoming wonky as the tumours interfere with my various bodily systems. The treatment? Elevate my feet, and wear super-tight compression stockings (I'll get thigh-high ones fitted in the next few days, ooh-la-la). I remain stupefyingly tired, especially on days like today when I decide not to take Ritalin to perk me up.

None of these symptoms will get much better. The only one that could is my voice, which has been nothing but a whisper for two months, but which I hope Dr. Anderson will inject or spray on April 25, and perhaps I'll be able to speak with my vocal cords again.

Real plans, for real. No really.

All the rest means that my wife Air and I are making plans, real plans, about what the next few weeks and months are going to look like. I am on the full B.C. Palliative Care benefits program—British Columbia seems to be in good stead when it comes to this somewhat uncomfortable specialty.

I have signed the official B.C. Do Not Resuscitate (DNR) form, so if I have a heart attack or other really drastic event, then my medical team—plus first responders and hospital staff—know that I don't have long to live, and don't want any overly-heroic treatments to keep me alive at any cost. In particular, there's no point in having me on a ventilator in intensive care when that space could go to someone who might make a full recovery and live a long life.

Emily the Burnaby Health Nurse comes again tomorrow to see what I might need here at home, so that I can stay as long as possible—and to determine who else on her team might be best to help my family and me figure that out. While Burnaby Hospital's Palliative Care ward is apparently extremely nice, and just down the hill, I'm not planning to go there.

Rather, we're physically preparing our house for me to live my last weeks to months here, and likely for me to die here too. Burnaby Health will even bring in a fully-adjustable hospital bed so I can set myself up comfortably.

Being the Decider

I may sound a little cold and matter-of-fact right now, but in truth it's surprisingly satisfying, even a bit joyful, for Air and me to be able to make decisions about how my life will end—and to know that these decisions will take effect not in some abstract future, but soon.

Personally I don't expect to live until autumn, and I don't know if I'll get very far into summer. But if that's the way it happens, I'd like to die during a beautiful Vancouver summer rather than one of our grimmer grey seasons. Once I'm dead there'll be no further experiences, so I may as well face a lovely city in the sunshine beforehand if I get the chance.

At the moment none of my doctors sees any particular single organ or physiological system as a big scary killer lurking to take me down suddenly, or with a series of cascading problems. More likely I'll continue to become weaker and more tired, and I may need some help breathing later. Then, eventually, weeks or a few months down this gravel road, I'll simply shut down, and I'll die. There won't be a Derek anymore.

That sounds like a decent way to go.

When Dr. Anderson, the ear-nose-throat (ENT) specialist I saw today, grabbed his nasal endoscope (which I fondly thought of as his "nose cam") and took a look down my throat—an interesting experience for me, certainly—he was surprised. As a result, he's not treating my laryngitis yet. Let's find out why.

He asked me to try to hum, and I did, producing no sound at all, as expected. One of the vocal folds in my larynx wasn't vibrating, also as expected. When I try to talk, only one of my two vocal folds becomes "adducted" into position, and with no second fold to vibrate against, no sound happens. That's what laryngitis, or dysphonia, is all about:

But the slack vocal fold wasn't the one everyone was expecting. With all the information in my cancer patient file, describing all the tumours in my lungs and around my spine, Dr. Anderson—like my doctors at the B.C. Cancer Agency's Pain and Symptom Management Clinic last week—figured some of those tumours might be affecting a particular nerve. That is the recurrent laryngeal nerve (RLN), which connects my brain to the left vocal fold.

Not the wacky nerve, not acid, not bacteria

For historical-evolutionary reasons, in most vertebrates (including human) the left nerve loops from the brain, way down into the chest, and then back up to connect to the left side of the larynx—yes, even in whales and giraffes, where the nerve makes very long detours. In my body, there are lots of opportunities in my chest for interference from tumours, swelling, and so on.

But the right nerve takes a more direct route from the brain to the larynx, and there's no evidence of cancer or anything else interfering with the performance of that nerve. And, in my larynx, the right side is the slack side.

Dr. Anderson peered around with his nose cam (glurk), and saw no evidence of scarring from injury, or stomach acid from my occasional vomiting, or bacterial infection—which the antibiotic I took last week would have addressed anyway. He asked me if my throat was or had been sore (no), if I had any troubles with choking when I tried to swallow (no), or if I had any throat spasms (also no).

Staying voiceless to reduce the risk

So he wants me to wait yet longer, and see if my vocal cords will heal themselves. Had my left vocal fold been slack, he probably would have treated it right away, because the source would be much more likely to be nerve interference, and thus perhaps permanent. Spraying or injecting the slack fold would snap it into the "adducted" position where the functioning one could vibrate against it. (I think he might use Teflon, though he didn't say.)

UPDATE: No, Teflon is not a likely agent, it seems, since there are newer and better things to try. So, no jokes about my non-stick vocal cords, I guess.

Sounds great, but he recommended against doing that to the right fold, because if it's not paralyzed by nerve damage, and isn't infected with bacteria, and doesn't seem to be affected by acid reflux from my stomach, it is much more likely to be something temporary, such as a virus. After all, my laryngitis began after my whole family developed a viral infection one weekend back in February.

I still have a chest cough, and my immune system is weakened, of course. Viruses can linger in my system for a long time, and if they've knocked out my right vocal fold, that could take weeks to heal. (My mother, by comparison, has been recovering from shingles for six weeks, much as my wife had to do back in 2004.)

So spraying my right vocal fold to lock it into position might be a bad idea, because if it can heal on its own, then both sides of my vocal folds will adduct naturally, and vibrate against each other, as they should. If it's locked into position, then only one side, the left side, will vibrate. It will work—though I guess my voice might sound different. I got the impression that the spray might also potentially injure the fold it locks into position, since that essentially forces it from abducted (open) paralysis to adducted (closed) paralysis.

Fear and frustration

It didn't occur to me until just now, and Dr. Anderson said nothing about this idea, but if we did snap the right side into a permanently adducted position, and later the RLN became injured because of pressure from my chest tumours and paralyzed my left vocal fold, I'd lose my voice again. I'm not even sure what the consequences and implications of that are. It would suck, to say the least.

So while it's tremendously frustrating, it does seem reasonable to wait. I will see Dr. Anderson and his nose cam again in a few weeks. I hope when I do, it will be with a naturally-recovered voice. If not, I'll plan to go with the spray then, and hope that will bring back my speech. In the meantime, if I talk to you, expect what I now think of as "the usual whisper."

While the general trend of my health is—as anyone should expect—downward, it's hard to know when I'm having a down day or two, as opposed to entering a new phase of declining health more generally. This past weekend, while my pain was better than average, my fatigue kept me pretty much stuck in the house hanging out with the dog, throwing up occasionally. I started to wonder whether I was suddenly becoming housebound. Yesterday's post gave you a clue to my mindset.

Yet today I was quite a lot better, more awake, able to do more chores (cleaning out the fridge, a bit of laundry), just generally feeling in a better mood, mentally and physically. I still didn't get out, but at least I felt like I could.

And tomorrow I will. I have an appointment to see an Dr. Anderson, an ENT specialist in Coquitlam, in the afternoon about my laryngitis. If anyone can find a solution, I'm hoping Dr. Anderson will be the guy. To have some part of my body start working relatively normally again would be a boost to my disposition. At the least, it would be nice if people calling on the phone could expect to hear and understand me clearly.

What is the verdict following my full weekend (62 hours) of self-imposed speechlessness? No effect whatsoever: my laryngitis (or, to introduce another term, dysphonia) remains in full force, and a whisper is still about the best I can do. So among the doctors' referrals I'm waiting for, I'm hoping the otolaryngologist (ear, nose, and throat) specialist contacts me soon.

Tomorrow it will be a full month since I stopped being able to talk full voice, or sing, or be heard in any but the quietest environments. It's become pretty damn frustrating, especially for someone who's usually as talkative as I am. Nor did I find the task of not talking on Saturday and Sunday the least bit fun.

The weather isn't helping. I perked up slightly yesterday when the sun came out, but Vancouver has returned to grey spring drizzle today. My aunt and uncle had enough of it last week, and took one of their regular trips to the Nevada desert. I can understand their motivation.

I've now had laryngitis, preventing me from speaking in more than a whisper or a rasp, for 24 days. I saw my doctors at the B.C. Cancer Agency yesterday, and they are referring me to an ear-nose-throat (ENT) specialist as soon as possible. Despite a couple of minor encouraging signs this week, simple rest and fluids didn't work, and an antibiotic didn't work.

My friend Evie suggested early on that it could be result of, or exacerbated by, a type of acid reflux. That's among the most common causes of laryngitis, and treatment for reflux (which she didn't know she had) cleared hers up after four weeks. It could be something more exotic, however (pressure on the body's most famous nerve, the RLN?), with potentially more exotic treatments (spraying one side of my larynx with Teflon?).

Anyway, we'll see what the ENT specialist says. In the meantime, my wife and kids are away for a few days, so I'm going to take the chance tomorrow (Saturday) and the day after (Sunday) to rest my larynx by not speaking at all. No whispering, no rasping, no nothing. Most of you won't notice, since you only see what I type anyway.

But I won't answer the phone. Whoever leaves a message will have to have some other way—SMS, text chat, Facebook, Twitter, email—for me to communicate back. Anyone seeing me in person will get messages written out on pieces of paper (yes, that's faster than an iPad, shut up).

Oft-time loner that I am, I suspect I might enjoy it a bit.

P.S. Yesterday my wife tweeted that I have "vocal cord paralysis," which alarmed a few people. I'll note that "vocal cord paralysis" and "laryngitis" mean the same thing (as does "I've lost my voice"): my vocal cords won't vibrate to produce sound. They describe a symptom, but not what's causing it, or what could treat it. A different name need not mean things are worse, or better, or different at all.

This weekend is brought to you by "The Big C" and the word phlegm—a word whose spelling I've always enjoyed. I do not enjoy horking it up all day, however. Time for bed.

UPDATE March 13: The coughing and phlegm have almost entirely subsided. I am much less exhausted than I was yesterday, though I am still pretty tired. Most annoying, in all my hacking, I pulled muscles on both sides of my ribcage and in both shoulder blades. I feel like I was tossed into a CFL football game. I hope I didn't actually crack any bones.

There are a couple of encouraging notes, however. First, I've been able to sleep on my left side, which I've always preferred, but which I've been unable to do for weeks, because of mysterious pains which also seem to have dissipated. Second, a teeny, tiny part of my voice seems to be coming back, the first sign in almost three weeks that I might regain the ability to speak.

I won't make any bets: my body has been a mess these past few days, and who knows what it will do tonight or tomorrow, but at least there are a few good signs. Now we need some damn spring weather.

A dying man can wish for many things, but one of them might be to have a party with many family and friends: like a funeral, memorial, or wake, but actually being able to be there, before he dies. That's exactly what my wife Air put together for me a couple of nights ago, on March 3. We had a "living wake" at the newly-renovated Waldorf Hotel in East Vancouver, with a couple of hundred of the people in our lives joining us for a great Lebanese buffet, lots of mingling and chatting, and some fine live rock-n-roll music from my old bandmates and me, as well as my friends in Vancouver's legendary group Odds.

We couldn't throw the invitations wide open because fire regulations restricted how many people were allowed in the grand tiki-themed room in the Waldorf's basement—and we wanted to make sure that the people who came really were those I knew, and didn't get crowded out. After all, it was a wake, not just a party. Luckily, we didn't have very many uninvited door-crashers (and a few guests missed out because of flu and other illness), so we stayed within the limit, and it all worked out.

A dress-up crowd

Amazingly, in fact, few people I wished I could have invited if I'd had contact info, and others I never expected to make it, showed up anyway. Some I hadn't seen in many years, or came from very far away, so that was a nice bonus too. There were family members I've known my whole life, and friends I've had for 10, 20, even close to 30 years. I think I had a chance to say hi to almost everyone. My apologies to the few of you I missed.

Most of them had their pictures taken in the photo booth set up by the awesome Miranda and Reilly of Blue Olive Photography. There are other pictures appearing on Flickr, YouTube, and elsewhere (such as blog posts) with the tag penmachine, with more to come (if you have any from the event, please use that tag yourself). You can also tag pictures and videos with my name on Facebook. We had this slideshow projected on the wall all night too:

I was shocked at how well I survived the evening. I did plan carefully: I took the right combination of medications at the right times, napped in the afternoon, avoided eating too much during the day, and simply ran on endorphins until almost the very end of the evening. During dinner I went upstairs and ate in the hotel room we booked, lying on the bed, to recover some energy. Then, after far more stints on the drums than I thought I'd be able to tolerate, I finally burned out and announced to everyone that I needed to lie down, then disappeared to let them wind things down. I paid for it afterwards, and all the next day, but it was entirely worth it.

Speaking of that announcement, yes, I still had (and have) complete laryngitis. Through the PA system, I rasped out a very few words, sounding like Christian Bale's Batman in The Dark Knight. Out on the loudness of the floor, I was completely inaudible unless I whispered directly into people's ears. I sometimes resorted to typing stuff out on my iPhone for them to read. It was bizarre and frustrating, but somehow appropriate—it was like being a speechless ghost, drifting in the semi-background at my own wake. It also kept anyone from trying to monopolize my time, since I couldn't engage in any serious conversation.

The thank-you brigade

Others made up for it. My wife Air coordinated the evening (and avoided crying, somehow), the guys in the band cracked the usual jokes, and there were four extremely short and touching speeches from those close to me: my friends Tara, Dennis, and Johan, and my (pregnant!) cousin Tarya (MP3 files, between 1 and 4 minutes each). We had tremendous help from my parents Hilkka and Karl (he made the slideshow too), our friend Steven, current and former members of The Neurotics and other bands I've been in, Pat and Craig and Doug from the Odds, the staff at the Waldorf, and our kids Marina and Lolo, who couldn't come because of B.C.'s stupid liquor laws, but who kept themselves and another friend's daughter entertained at home until we got back late.

My biggest thanks, of course, go to Air. It was all her idea, and her work that made my living wake happen. She has kept our family going through my four-plus years of cancer, through surgeries and fear and chemotherapy and a prognosis of death. She made this party happen now, while I could enjoy it and join my friends and family, instead of after I die when I can't. We've been married more than 15 years, and I've said before: that is not nearly enough.

Thank you, too, to all of you guests who could come. I'll remember it my whole life. I hope the rest of you will remember it even longer.

My laryngitis has degraded from Godfather-ish croak, past Gollum-style rasp, into nothing but a voiceless whisper. Yet, despite a visit to the local medical clinic this morning, there's nothing quick I can do about it.

It's not a bacterial infection, so antibiotics would be no use. The doctor herself said she had similar laryngitis for over a week recently, and her only recommendations were to rest my voice, drink lots of fluids ("whatever you like," were her words, though I suspect vodka wouldn't be a good idea), and wait. So, most likely no podcast recording this week, probably no radio interview with Nora Young for CBC's "Spark," and at the party I'm attending later this week, at best a few perfunctory thanks from me through the PA system.

Definitely no singing, not even Tom Waits songs. Perhaps especially not Tom Waits songs.

Over the years, in the throes of enthusiasm about a particular topic of conversation, I've been prone to letting my speaking voice get louder than might be appropriate, sometimes in public places like restaurants. I'm not a believer in karma, but if you are, feel free to consider it applied, however gently, to me in this case.

UPDATE Feb 28: Off to see the doctor. Still no voice, still a low-grade fever. Need to get the professionals involved.

Somehow, my daughter Marina's iron constitution has protected her, but her sister, mom, and I have all been hit by a low-level flu virus over the past week. Needless to say, in my already weakened state, I got whacked pretty hard. Still, I'm recovering okay.

However, strangely, I've completely lost my voice. I've had that happen before, briefly, for a day or two—sometimes I've even had a cold give me a temporary deep radio-announcer voice. Decades later, I also recall the cruelty with which my elementary-school cohorts and I laughed at our grade 5 science teacher, whose macho male voice was transformed by any chest cold into that of a squeaky cartoon character.

But I've been unable to speak in anything but a raspy Vito Corleone whisper since last Tuesday. I've had to postpone both a podcast recording and a radio interview twice, and I'd planned on giving a little talk at an event later this week; I may remain largely mute instead, although things might improve by then too.

I've always been a chatty guy, so it's bizarre to restrain myself from talking. If the condition persists, I'll have to ask a doctor what to do. I'd like my vocal cords back.