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Why You Never Ignore A Serious Symptom

By : on : January 25, 2018 comments : (0)

An Inspiring Story About a Fellow Speech Pathologist Who Lost Her Voice

I wanted to share a fascinating story of a fellow speech pathologist, Erie Louison, MA, CCC-SLP, which originally appeared in the ASHA Leader in October 2017. It touched me because her story involved a voice disorder. Not only that, this story highlighted how important it is for all of us to PAY ATTENTION when you experience a symptom that is not normal. If you don’t, something that seems annoying could literally be life-threatening.

Erie, a speech-language pathologist in a private pediatric clinic, had been wheezing for a few months, but she chalked that up to seasonal allergies, so she thought nothing of it. Until…she rushed to the emergency room with severe chest pains in July 2016. The diagnosis was a complete surprise: a multinodular substernal goiter. Her thyroid gland had tripled in size and had grown into her chest cavity. Worse yet, the goiter was compressing her trachea. Left untreated, the goiter would have closed off Erie’s airway.

A total thyroidectomy was recommended; the surgery was done through Erie’s neck, rather than through her chest. She had been advised before the surgery that damage to her vocal cords or laryngeal nerve could occur. After surgery, she found that she had difficulty speaking and coughed while eating and drinking. Using a mechanical soft diet and thickened liquids, Erie’s swallowing soon returned to normal, but her speaking was barely above a whisper. She could only get a few words out on a breath. She avoided the phone, couldn’t sing, and of course, couldn’t work. (Imagine a speech pathologist with no voice!).

An ENT (ear, nose, and throat physician, or otolaryngologist) diagnosed right vocal fold (cord) paralysis. He recommended an injection procedure known as vocal fold augmentation, to “bulk up” the fold with a “filler” gel, to help it meet the other vocal fold, thus creating a stronger voice. An injection is often used in cases of vocal fold paralysis, vocal fold atrophy (often due to aging), or in some cases of vocal fold paresis (weakness). It’s a temporary fix, but the hope is always that if the nerve is damaged, it may heal, allowing the affected vocal fold to return to normal.

The vocal fold on the right side of this picture is paralyzed, so that the vocal folds do not close completely during phonation. Photo courtesy of New York Eye and Ear Infirmary of Mount Sinai.

Normally, open vocal folds form a symmetric “V” shape. The vocal fold on the right side of this picture is paralyzed, so that it cannot move outward or inward. Photo courtesy of New York Eye and Ear Infirmary of Mount Sinai.

In this patient with longstanding vocal fold paralysis, the paralyzed vocal fold has lost muscle mass and has become thin and atrophic. Photo courtesy of Voice Medicine, Lucian Sulica, MD.

Indeed, Erie did notice improved vocal volume after the injection. Her voice quality went from breathy to sometimes raspy with a deeper pitch. However, persisting vocal fatigue kept her from doing her work as a speech-language pathologist.

As if the situation could get any worse, Erie was then diagnosed with reflux, which was felt to be hindering her recovery of voice. This was managed with medication. Within a month, her voice started sounding stronger with clearer quality. Within a few short months, she returned to her job full-time.permission to reprint

The paralyzed right vocal fold is on the left side of the photo (the image always appears reversed). Notice how weak and breathy the voice is, since the vocal folds can’t close completely.

Erie believes that she has regained 85% of her old voice. She still gets hoarse at the end of some days, and she has to be very faithful to her vocal hygiene regimen. She can sing with her students again, but her range is lower. Also, she can’t project her voice the way she used to, but relies on a microphone, something we advise all classroom teachers to use to preserve their voices in the classroom. (After all, if you’re not getting paid to be loud, don’t give it away for free; let the microphone do the work for you!)

I found it interesting that through this entire process, Erie did not receive any vocal rehabilitation therapy. I corresponded with Erie briefly to get her permission to reprint parts of her story. She stated that since she had worked with voice clients in the past, she used some of those techniques on herself. It’s certainly possible that, combined with injection augmentation, she could’ve obtained a faster or better result with her voice, had she been recommended for specialized voice therapy. Since she stated that she still has a paralyzed cord, she may be a candidate for an implant procedure, called thyroplasty, which is a more permanent fix for vocal fold paralysis. (Implants are customized for each person’s vocal cord situation).

It is so interesting that Erie feels that her voice and swallowing problem gave her a new perspective on what her clients experience: the fear, anxiety and uncertainty of what will happen to the ability to communicate. She could understand the frustrations of someone who can’t communicate or swallow normally.

She also realized that in this world of social media and online networking, she found support and guidance from the community of speech-language pathologists and other online groups. She has become inspired to develop her professional skills even further: pursuing a doctorate, writing, and teaching.

So, what do we learn from this courageous woman’s story? Perhaps most important from a medical standpoint: don’t ignore a new persisting symptom. It might be more serious than you think. (Even if it isn’t, better safe than sorry). Also, don’t give up in the face of adversity: do your homework, search out answers and get expert help. And most inspiring of all, let your difficult experience become the impetus to become the best version of yourself, find empathy for the plight of other people, and reach out to help others. In fact, don’t wait for adversity. Always strive to be the best you can be, and do the most you can for others who need your help, support, and caring.

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