Ok, I promised to write some more
So on Tuesday was the examination - quite comprehensive, but they did not do a voice range test. Dr Kim did his camera check and asked questions. (One of them was "When did your gender identity change"
- I said "never?" - LOL - I hate these sort of questions). The camera check was ok. better than the ones with the camera into the mouth, where I usually gag, but they did that one later, too with a high speed image camera. Interestingly they managed to do ith without me gagging - same as later the infusionfor the surgery - I have no haemmorage there now - for the first time. They really are super careful...
So the check with Dr Kim pointed towards a multiple diagnosis. The usual "vocal tremor" which is his favourite of course, a strong assymetry of the vocal folds, a frontal incomplete glottal closure and of course the androphonia - low pitch. He said the surgery can correct the pitch and assymetry but the other things have to be treated with botox and voice training and hopefully will get better once I do not have to fake my voice anymore.
Then I did the voice examinatio first a video of reading the rainbow passage and some other stuff, then another readong of a new passage, tha "grandfather passage" for the computer. Each time I was supposed to read it in my relaxed and my trained voice. I did not manage to totally relax though, so I think I could have gotten lower. The result was the relaxed one was at 133 Hz the elevated one at 188 Hz. Then some tests with glottal pressure and air flow and more photos and videos of my vocal folds with cameras in my mouth. The result was that I have a 4 times higher pressure on my vocal folds which causes them to "smash together", but I loose a lot of air because of the incomplete glottal closure, so I use 3 times as much air as normal. They also did blood tests (I guess mainly coagulation and liver tests), a test if I am allergic to the antibiotics (no one ever did that in Germany when I was given antibiotics), an X Ray of the chest (with an awfully old looking machine :\ ).
Dr Kim strongly emphasized the importance of getting used to the new vocal folds post op with voice training and suported by the Botox. He recommended 8 months of Botox or the medication. So basically 4 months Botox and then 4 Months of the muscle relaxant. This is long. I mentioned I have a history of depression and am worried a bit about the medication, so he said he will give me a second one that I could use in case the originaly one is too much affecting me. If all works out, I should get rid of some of the other issues with the pressure and air flow as well.
He did explain some of the surgery there. Also the main differences to other surgeries that are similar. A major difference is that he uses permanent sutures, he said the thread used for that can be made more tight and last long enough for the 2 month healing period. Other threads could open by themselves or dissolve too early (which is what happend at my last genital correction surgery). I can imagine it also gives additional support in the long run. The other big thing is that he makes a deep suture. He does not only sew together the vocal folds, but also the tissue beneath that. This means he can avoid a pocket forming, which would cause turbulence in the air flow and cause a breathy or hoarse voice (as I heard it from many other people who had glottoplasty with other doctors), and this trick also makes the new commissure, the little V where the vocal chords meet, more stable. Additional stability is created by scar tissue between the new commissure and its original place at the cartilage. That way it is more stable and less likely to shift or move or swing, which would cause pitch instability and hoarseness.
Surgery was yesterday - he explained again something about recovery, estimated that my pitch increase would happen between month 2 and 4 given my condition and my vocal fold length, which is not too long apparently. He only will do two stitches and he explained again about the Botox. It goes into the muscles outside the vocal folds. Some thyroid (?) muscles, but not the vocalis muscle. If I get this right, this means that one has a limited voice range because of that during the first months. He said the first week I should be absolutely silent (which I found to be impossible because sometimes I need to cough a bit of phlegm up and in a half wake state in the morning I mumbled 2 words today, but I give my best) - then 3 more weeks of silence or saying a word or two intentionally. Then 4 weeks of minimum conversation and after 2 months the full voice use and beginning of voice therapy.
Surgery was ok - My main complications were some swelling in the hand of the infusion and severe neck and head pain, but my sensation in the tongue is all right, I mentioned I am sensitive to it, so he took extra care of it, asked me about my teeth, if they are all ok. They still are. The neck pain comes from overstretching hte neck in order to get the tools into it and the headache from the anaesthesia. Apparently I coughed a whole lot while waking up from the anaesthesia without having memory of that. I hope this is all right. I needed the full 3-4 hours then after that to recover enough to go back to the hotel by taxi. I was not feeling so wekk because of the pain, but I enjoyed the ice cream and cold water as well as the hand warm soup later on. No hot or spicy food for the next days... I had to cough again some times during the recovery.
Then he did a post op check - with camera. He showed me the pictures and the suture looked great. To my eyes it looked like he has reduced it by more than 1/3, but that could be a misperception. The whole thing looks more like a y than a Y, with the new commissure being off axis by a good part because only that way he could correct the asymmetry. Now both sides are same size, that should be good. Everything seems to have gone very well.
Taxi back to the Phil House cost 6000 Won and was fast. Then I needed a night to recover, eat more ice cream from the store next to the house and sadly could not really sleep well. Jetlag plus the Koreans seem to like to have very hard beds. Even in the clinic, the bed was very hard and uncomfy for me, I am used softer beds from home and clinics in Germany. I hope I can find more rest. first day post op I am pretty much awake and feel fine, but I was sleeping - or trying to - until midday. So no sightseeing today, but getting food later on.
I had some trouble with finding affordable food here, many places are expensive, but some seem to be reasonable, expecially the ones not selling western food. Also the ATMs apparently often do not take Maestro cards, which is annoying and we still have to find one that does to get more money.
Jessie was super helpful and nice. I also got a package with medication for 7 days, antibiotics and stuff that makes it easier to get rid of phlegm, but no cough suppressant - but I brought some of that myself. Also post op instructions and some papers with important sentences in english and korean to get around.
I feel amazingly little pain - just like one would have if one had a laryngitis or bad cough before - so it is really a mental issue to keep the silence as not much physically reminds me of having had the surgery.
So far, so good. Now 7 days of voice rest, sightseeing and then followup and return flight, hopefully with less interference from stupid people in Bejing who do not know that some people need a lot of medication and an inhalator device to prevent too much dry air from damaging a strained voice.
Greetings
