Random Thoughts

Whispering Ed

... you have saved my world!

by Ed Boyd

I was barely able to speak above a whisper after a surgery to repair a false aneurism in my neck. This is what happened.

I have a long history of struggling with skin cancer. The main culprit is something called squamous skin cancer left unchecked may invade the interior system. Several years ago, I had a squamous skin cancer removed via Mohís surgery from behind my left ear. Mohís surgery is a special technique for treating skin cancer by systematically removing thin layers of cancer, examining microscopically each repeated layer until it is determined that there is no further evidence of cancer. The surgeon takes a layer of skin, cauterizes the lesion, and while the patient waits to see if further surgery is needed, the surgeon examines the tissue.  It can take as much as 30-45 minutes before the patient is told whether further such surgery is necessary. It is common, as it was in my case, to have 2-4 such repetitions. A year or so later another squamous skin cancer was diagnosed in my left neck. More Mohís surgery was necessary to remove that.

Another year or so went by when I noticed a lump in my neck. The cancer had invaded beneath the skin and now had to be excised by a vascular surgeon. This was done and the referred oncologist also recommended that radiation therapy was necessary because of the ďaggressiveĒ nature of the cancer. A radiation oncologist plotted the necessary radiation treatments for thirty sessions, 5 days per week.

I remember being really spooked by this procedure. For a while, I could not figure out why I came close to panic when climbing on the x-ray table. I knew that that x-ray was not going to cause pain. The procedure was for me to lie on my back and have my head taped to the table so my head would not move. The machine would rotate above my head so as to shoot an x-ray beam into my neck from both sides. Each session was no more than 8-10 minutes. I felt panic, head to toe, and felt an impulse to jump off the table. I knew how unreasonable I was being and knew I had to find a remedy. Somewhere along the way, I struck on the idea of concentrating on sending myself messages in Morse code. I had learned Morse code as a signalman in the Navy. At the time my granddaughter, Courtney, was about to have her 10th birthday. I made up a message, Courtney (-.-. --- ..- .-. -. . -.--) is (. Ö) ten (- . -.) today (- --- -.. .- -.--) I would quietly lay on the table sending such messages to myself till I was told the session was over. This was how I saved myself anguish and embarrassment.

After a week or so, it did come to dawn on me why I was so phobic about a relatively benign process. When my father was terminally ill from brain cancer, I drove him for radiation treatment to MIT, the only place at that time in the area with the special radiation equipment being recommended. We made only a couple of such trips before my father said he thought they were trying to kill him. Indeed, it was a last gasp, as my father was dead within a month or so. Iím convinced that my phobic reaction was connected to having to experience my fatherís difficult death 30 years before. A remembrance of driving Pop to his doom, so to speak.

So now, Iím thinking and hoping that I have rid squamous skin cancer forever. It turns out that this is a relentless demon chasing after me. On the drive back from our March 1997 trip to Florida, I discovered another lump in left neck as before. The day after getting back, I called the radiation oncologist from before and he saw me immediately. The news was that there was very likely a reoccurrence of skin cancer that probably would require a neck dissection. I was referred to an otolaryngology surgeon who was being highly recommended.  

So I went off to see Dr. B. who I liked right away because of his apparent competence and sensitivity. He said that he should take out the tumor, frozen section it and if it proved to be cancer, as he strongly suspected, he should proceed with a neck dissection. Neck dissection means that all surrounding tissue in the neck area literally has to be cleaned out so another cancer cannot reside there. In preparation for that, Dr. B. arranged for a neck and chest CAT SCAN at MGH in search of further possible evidence of cancer. More, bigger trouble. CAT SCAN showed that the left carotid was about 85% blocked and there appeared to be a small tumor in my left lung. Instead of one, now I need three surgeries. So on July 3, 1997 Dr. W. a thoracic surgeon removed a small tumor from my left lung, my demon squamous skin cancer that had metastasized to my lung.  As I sat looking out of the window of  MGH Ellison 15, at least I had the 4th of July fireworks from the Charles River Esplanade to entertain me. What a way to spend 4th of July!

About a month later, after healing from lung surgery, I presented myself at Melrose-Wakefield Hospital for a combined neck dissection followed immediately with carotid unplugged and repaired.. First Dr. B. cleaned my neck out and then Dr. H. cleaned out and patched up my carotid artery. All of this took about 5.5 hours. I spent a night in intensive care as is customary for carotid surgery. I had a couple of rows of staples running zigzag up and down and across my neck mindful of the character played by Raymond Massey in ARSENIC AND OLD LACE. When Ellen, my oldest daughter, came to visit the next day, she took one look and burst into tears. She let the other family know what they were in for so others were more restrained when their turn came to visit. Catherine, my wife, had seen so much gore, as a surgical nurse almost was able to conceal her distress over my temporary disfigurement.

After such an onslaught, you canít help wonder where demon cancer is going to strike next. My recovery was surprisingly quick and I was back to work and playing golf in about 5-6 weeks. Except a not too visible indentation in my left neck, I felt about the same as before. After a year or so of frequent checkups, I began to feel that maybe my travail was over. I didnít say this out loud, though.

We were in Venice, Florida in March 2001, when I first came to notice a small bubble in my left neck. Here we go again, ď Shit another lumpĒ, I said to myself. Thinking that my demon cancer was back, I went to see Dr. B. the neck surgeon. He reassured me that he was pretty certain that the lump in my neck was not a re-occurring cancer. He said that it was more likely an issue for Dr. H. who had done the carotid surgery. He said if it were ok with me, he would call Dr. H. right then. I was not present when that call was made, but Dr. B. came back with a message from Dr. H. saying his office would arrange for an ultrasound examination of my neck. After I had the ultrasound, I went to Dr. H. who said I had a false aneurysm in my neck. He said that the carotid graft that had worked loose probably caused the bubble. The problem he thought was because there had been a lot of muscle and tissue removed from my neck through the previous neck dissection. This made it difficult to anchor the graft.

The recommendation was to watch the bubble to see if it got larger. If it stays about the same, it is probably best to do nothing. I sure wanted to do that. After a month or two, Catherine said that risking offering me bad tidings; to her the lump was noticeably larger.  As usual, she was right. Catherine had been a surgical nurse for many years. I knew she was right.

So off I went to Dr. H. who said he should do a surgical repair. I asked about risk. He said there was a risk of stroke during the operation. He thought that this was not too probable, as he would not have to occlude the carotid artery for very long. He felt the surgery to be relatively simple. If I choose not to have the surgery, the carotid graft could rupture at any time. Reluctantly, I agreed to have the lump in my neck fixed.

Surgery was scheduled for 6 weeks later. As I waited, I found myself feeling similar to the spooky sensations I had when having radiation treatment in 1995. As my anxiety mounted that I could not explain, I decided to seek out help with a local hypnotist that I had learned about.

I met with a young woman hypnotist for two sessions. The first session was to get information from me that could be developed into a script that would be used to induce the hypnotic session to follow. A few days later, the second session began with me arranging myself comfortably in a deep reclining chair. Soft music was playing in the background. Pam, the hypnotist, began reading from a prepared script in a soft but firm voice with suggestions like, ďSurgery that I will safely undergo is for my benefit.Ē ď The recovery will progress easily and quickly.Ē The session lasting about 25-30 minutes was tape-recorded. I was given the tape and encouraged to listen to it daily. I used the tape regularly feeling that it gave me an active way of engaging in anticipated surgery instead of just stewing about what I dreaded.  I believe that the tape was a real help perhaps mostly because I wanted it to.

Why was I considerably more anxious about this surgery than I remember being about the other surgeries? One association I had was a similar remembrance regarding radiation in 1995 related to my fatherís death. My foreboding may be coming from that my father died at age 69, just short of his 70th year. In November 2000, I had my 70th birthday. This meant that I had outlived my father. Maybe there is something in my viscera that says I am not entitled to outlive my father?

On August 6, 2001, I presented myself to the Melrose-Wakefield Hospital at 6am for still another surgery. I felt as calm as I might be given that I was about to be knocked out and carved up.  It was of great comfort to have my wife of almost 48 years wait patiently with me till I was carted off to the operating room. I truly believe, too, that the hypnotic tape helped a lot.

As I became conscious of being awake following surgery, I felt an immediate sensation of elation. I made it, I thought, as part of me didnít expect to. This feeling continued to settle in as I was wheeled of to intensive care. Not too long after I was settled in intensive care, Dr. H. stopped to ask me how I was feeling and said the surgery went extremely well. He seemed so pleased he told me he had pictures taken and was considering whether he might want to publish the process in a medical journal. The only real discomfort I had was the hoarseness in my throat. Dr. H. said it was because of the anesthesia tube that would go away in a day or two.

Normal procedure for carotid surgery is to spend recovery in intensive care so as to be watched intensively for 24 hours. Every few hours a nurse would test reflexes like having me squeeze her hands and stick out my tongue. Failing such tests, the surgeon might be called immediately. My recovery went so smoothly that Dr. H. discharged me from the hospital by noon the very next day. Dr. H. said I should call his office and make an appointment to have the stitches taken out in a week.

My recovery, too, went surprisingly easy. The main aftermath was my raspy throat and grogginess from the anesthesia. I had little pain because of Dr. H.ís skill and because, I suppose, there were not many nerves left in my neck from the previous surgery.

My throat was still hoarse as I went to have the stitches removed. Dr.H. said that if my voice doesnít return after a while, I should have Dr. B.,  (the ear, nose and throat who had dissected my neck) take a look.  After three weeks, as still raspy voice, I did just that. Dr. B. squirted anesthesia into my nose and then inserted a fiber optic device into my nose that descended into my throat for him to look at my vocal cords. The procedure wasnít too pleasant but it didnít hurt. The examination suggested that, as the vocal cords were not joining properly, the vocal nerve having been damaged somehow during recent surgery. How it happened and whether the damage was permanent could not be determined. Sometimes it can take as much as 6 months to a year for recovery. The only advice Dr. B. could give for now was to wait. If after six months or even as much as a year there was no response, then there is a surgical procedure that has been successfully used to recover voice.

So at the moment it seems that my surgery foreboding was not totally unwarranted. Iím thankful Iím still here but Iím limited to a degree that I never expected. I can still converse with Catherine, family, friends. One of my grandsons thinks I had my tonsils out. The problem is that I canít do the work that has been so important to me.

I retired my full-time job as Clinical Director of North Essex Community Health Centers, Inc., Newburyport and Haverhill in 1995. I was asked to stay on part-time to chair clinical conferences, twice a week, and to teach a graduate intern seminar. These were two activities that were part of my full-time job. Both tasks require a responsiveness and verbal fluency that I cannot exercise at the moment or ever. For the past several years, I have through these activities sustained a professional life central to my experience. Freud said, ďLove and workĒ are indispensable to human life. Each week after conferencing and teaching, I could usually feel I had made a contribution. I enjoyed the good fortune of having many persons over these years very generous in their appreciation for my efforts. Iím in a quandary at the moment, not knowing how to fill the void.
                                                              
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I had been told that spontaneous recovery of voice might happen at any time. For the next several months, I found myself anticipating each day, trying my voice to hear a change. Each raspy day was a disappointment, frustration mounting as time went on. Somewhere toward the middle to end of month three I had a severe chest cold. My chest was full and I coughed endlessly. Coughing is natural for chest congestion, but is especially problematic for paralytic dysphonia. Paralyzed vocal cords make the production of cough mucous problematic. The cough spasm doesnít work like it should. One afternoon I was lying in bed, licking my wounds, when called to the phone. As I answered the phone, I was astonished to hear the sound of my normal voice. Elated, it occurred to me that I was having a spontaneous recovery of my voice that I had been told might happen.   

I made the mistake of calling a few friends to tell of my voice recovery. As my heavy cold went away, so did my voice. Apparently, the congestion had the effect of bridging the gap between my vocal cords giving me only a temporary, pseudo recovery. This was the explanation given to me by the otolaryngolist. This event, too, was further evidence that a spontaneous recovery was more unlikely. On the other hand, the congestive pseudo recovery suggested that a surgery for paralytic dysphonia could be successful.

After 6 months of raspy frustration, I was referred to Eye and Ear Infirmary to Steven Zeitels, M.D. After taking my history and examining my vocal cords, Dr. Zeitels agreed that spontaneous voice recovery was extremely unlikely. He also was very encouraging that my paralytic dysphonia was exactly the type of problem that is very responsive to the surgery that he was proposing. I had arrived at Dr. Zeitelís office armed with a paper he wrote subtitled: A New Approach To Paralytic Dysphonia. From the article, I already had a good idea about the details of the surgery. With that information and my very positive feelings of Dr. Zeitelís confident enthusiasm, I elected to have surgery on May 2, 2002.

The surgery is done under local anesthesia. It is essential that it be done with local anesthesia, as the surgeon has to have a way of knowing what he is accomplishing. I could feel tugging and pulling, a little, as Dr. Zeitels operated. Somewhere along the way, Dr. Zeitels said, ď Say 1, 2, 3, 4, 5.Ē  After I said this two or three times, I was sewed up and sent to the ICU. Miracle of miracles, I had immediate voice. As far as I could tell, I sounded as I had spoken prior to the vocal nerve damage. Surgery is accomplished by stretching the cord and by packing Gortex material among the cords. This has the effect similar to the congestive pseudo recovery I thought had happened earlier. This time, though, Gortex is sutured in place. Amazing! I mean Gortex is the same material made out of my golf rain suit. I guess this is a good sign that Gortex wonít shrink or leak.      

Shortly after my recovery of voice, I gladly accepted an invitation to convene two sessions of Family Therapy in July for staff at the agency I worked at prior to my vocal nerve damage.  In a recent office visit to Dr. Zeitelsí I said something like, ďYou know, Dr. Zeitels, its not uncommon for appreciative patients to thank their doctors for saving their lives. Dr. Zeitels, you have saved me my world!Ē


July 3, 2008

  








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