Thursday, January 13, 2011

The ENT

Mason and I just got back from a visit with an ear, nose, & throat specialist. He is still having problems with his airway (he still can't swallow liquids very well), and the speech therapy specialists at PCMC thought he might have possible vocal cord paralysis.

We went in for the appointment, and they had to stick a scope down his nose so they could see exactly what was wrong. I thought (for some reason) that the tube would be stuck down his throat, and so I prepared him for that. In fact, he talked about it with me, and was ready to let them do it. But instead, it had to go down his nose, and he was very upset when he found that out. Poor boy!

He was upset, and then when the tube went down, he gagged and began throwing up. The doctor apologized for how long it was taking, because he couldn't see anything with all the vomit coming up. When Mason began throwing up, the doctor asked: "Is he having nausea from the chemotherapy?"
To which I replied: "Yes. Oh, and um........I forgot to mention that he has a very easily triggered gag reflex." Whoops!

They weren't prepared for the vomiting, so they didn't have anything to catch it in. The Nurse grabbed some nearby paper towels, but it still went all down his shirt. With me holding a screaming Mason, the Nurse holding his head and the paper towels, and the doctor holding the scope, trying to get a good look, it was an awkward few minutes.

Mason did get a few good kicks in, though ( at me, and the doctor). Even though I feel bad about the doctor getting kicked, I'm past the point of trying to correct that, since it's only a natural response, and I bet it makes Mase feel real vindicated. I'm calling it therapeutic, and turning a blind eye. :) He was also angry enough to yell things like: "Take it out right now! RIGHT NOW!"

When it was over, the only thing he was really upset about was the throw up on his shirt. He was so embarrassed to walk across the hall to the bathroom to get cleaned up, because people might see the throw up. I ended up taking his shirt of, cleaning his chest, and then just putting him in his jacket to take him home. He fell asleep before we got there.

Anyways, the results are that he does have damage to his right vocal fold (vocal cord paralysis). It doesn't close all the way, which means that food, liquids, and saliva can all get through the opening, into his airway.

I wanted to see pictures of the vocal cords to understand it better, and thought others might, too. So here are some pictures to help you (and me) better understand what's going on.

This is where his voice box is, with a view of the vocal cords on the bottom right:


Here is a close up of his vocal cords. The white parts on the side are the vocal fold, which open and close over the trachea (windpipe). When we swallow, they meet in the middle to close the opening and keep all the food and liquids out of our lungs. But with Mason, the vocal cord on the right doesn't close, leaving his airway exposed on the right side when he swallows. It can also give him pain when speaking, and shortness of breath; he has both. 


If you want to see how the vocal cords work together, you can watch this youtube video. But it's a little disgusting, so be prepared.

The reason the happened could be a number of things. My best guess is that it's because he was intubated 4 times in just 2 weeks; once for each of his 3 surgeries, and another time for an MRI, because they were worried he would vomit and then choke while laying on his back. I could be wrong, but I don't think I am, especially because he didn't have this problem until after surgery, and I was told that it was a common side-effect of the surgery. I was also told on Monday, that the chemo could be making it worse than it already was, so this could be why it isn't healing like it's supposed to.

And in case you're lost, when he is intubated, they stick a tube past his vocal cords, and into his windpipe so they can keep him breathing safely. This is routine when someone is given general anesthesia for surgery, but it can also be done for other things (like an MRI, if needed). The tube I saw for his first two surgeries was pretty wide. It could have been connected to a smaller tube inside his throat, but this is the size of the tube that was sticking out of his mouth when I came in:
 If you're curious, you can watch lots of videos of intubation on YouTube. This one is a good demonstration.

So from here, there are a couple of options:
1.) He can begin swallowing therapy, which will tech him how to swallow better with the vocal cord paralysis. He would learn things like how to tilt his head a certain direction when he swallows, to help the food pass his vocal cords. If we go this way, he would just do this until it heals. If it heals.

2.) Another option is to have another surgery, where he would be given an injection that will push the right vocal cord to a closed position. It's not a permanent fix, but it will last for about a year, and the hope is that by then, his vocal cord would be working again. The surgery would require another intubation, and would last about 30 minutes.

3.) If his vocal cord doesn't heal, he would have to have a bigger surgery to fix it. This is more of a last resort, though, so it's we're not really thinking about it yet.

I'm not sure which one we'll do, yet. If we do the injection, the perfect time for it is in about a week, when he finishes radiation and has the four week break from his chemotherapy. I'll keep you updated when a decision is made!

Oh, and by the way, if both his vocal cords get damaged (which we were warned about before the surgeries), he would require a tracheotomy.

4 comments:

  1. Best wishes on your decision. It always takes a leap of faith. You and God make that decision together and you just go forward and hold God's hands and hope for the best. I find those videos so fascinating. Each time Kirsten has had a surgery I just look forward and not backward. When they divided the left and right hemisphere in her brain (except for the ends) they told me of the possible side effects. Does she continue to have further brain damage with the drop seizures or do we go ahead with surgery? Many questions, many scenarios and you just leap forward! Her surgery was a success and the results and yes, she had some minor side effects. You're in our prayers. ♥

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  2. Poor little guy =( He's been such a good sport too, I think the kicking is totally validate ;) Anyway, I hope YOU are holding up alright too! Can't wait to see you this weekend.

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  3. Thanks for keeping us all updated! I hope you guys can get this fixed easily and without any more trauma to poor Mason! You guys are both such fighters, keep it up!

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  4. oh, yuck, yuck, yuck! poor mason! i'm sorry you are faced with a tough decision like that. we will be hoping and praying that it will fix itself with time. keep us updated!

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