What first, the chicken or the egg?

[windsofchange]

Hi ladies,

As I begin my journey (in my late forties I might add, bleh), one that many of you have already undertaken, my head fills with questions... trying to limit myself to asking only the really, really, really ( emphasis intended  ) pertinent ones has been rather problematic   but here goes:

I'm set for my FFS consultation with Dr. Ousterhout in January, optimistically looking towards late spring/early summer for FFS.  Undergoing fast-track electrolysis with E3K in Dallas.   I'm also considering other, more cosmetic/vanity procedures with Dr. Cardenas.  SRS is on the horizon somewhere.

My dilemma is that I want/need VFS and, based on my research, Yeson is my one and only choice.

Therefore, (finally) the question: is it better to have VFS as the last "big" procedure in an attempt to limit the exposure of my vocal cords to the trauma associated with endotracheal intubation for anesthesia or, if the risk of traumatizing my cords by intubation is small, is earlier VFS appropriate?

My sincere apologies for droning on and on, but of all the questions I have identified thus far, this one plagues me the most as it directly impacts the timing of all the other procedures I have planned.

I'm so thankful for all of the candid discussions and the sharing of your personal and intimate experiences...I can honestly say that I'd be lacking in focus, direction and wallowing in self denial without you all.

Big hugs,

Allie

[abbyt89]

Jessie at Yeson told me I didn't have to worry about future surgeries, but to let the anesthesiologist know that my vocal folds are smaller and to use a smaller tube.

I'm having FFS with Dr. DiMaggio and a few weeks and he said there is no issue with the smaller vocal folds and that lots of his patients have had voice surgeries and he's had no problems with the intubation.

So I wouldn't worry about any future surgeries - after all cis women have smaller vocal folds and they go through surgeries fine.

[windsofchange]

Thanks for the almost immediate reply to my question... whew, your information gives me such relief.

A-

[anjaq]

Is there a way to keep some info on that in your pocket for emergency surgeries? I guess they usually choose the intubator size from the size of the voice box from the outside and then in case of a Y-suture that would lead to a misjudgement. Are there any ways that can be used? I guess people with Diabetes or Allergies whave to carry some information on that as well, dont they? Ok, I guess I have to ask the doctors here as it probably is different in the US...

[windsofchange]

Although I'm not a licensed/qualified physician, I am medically trained and credentialed at an advanced level and have been so for nearly two decades (oh my!, how old must I be  ), so, with that being said... I can relate my own personal/professional experience here...often, the choice of ET Tube (ETT) size is either:
1. based on a "standard" 6.5-7ish for average females and 7.5-8ish for average males; or
2. based on an estimate of the trachea's diameter from the size of the fifth (pinky) finger.

In an emergency situation, there is no time for a look-see at the glottis/trachea/vocal cords to get an ETT size estimate, however, humbly, if it were me and the choice was possible damage to my delicately altered vocal cords or asphyxia, hypoxia, and other really nasty things...I'd happily run the risk of damaging my cords.

However, on a lighter note, it is very reasonable and prudent to confer with your surgeon and, perhaps more importantly, your anesthesiologist prior to any procedure to make them aware of your markedly narrowed glottic opening/vocal cord shortening. I can assure you that they would be MOST appreciative of the advanced information so they can take steps to limit their exposure to liability by utilizing an inappropriately sized tube.

Please don't interpret this as medical advice, merely a recommendation from a caring soul who has performed many endotracheal intubations.

As a sidebar, Jessie told me by email yesterday that two months is the magic time.  Yeson (via Jessie) doesn't want you to undergo any procedure requiring endotracheal intubation for the two months prior to and the two months following your VFS...Me personally, I think I'd be inclined to wait a bit longer afterwards...but that's just my OCD kicking in lol  ...see my question and her reply below:

"My question is how long after VFS am I able to undergo surgery with endotracheal intubation?  There are several additional procedures I would like to undergo, but I want to make sure the timing is appropriate."

[Jessie's Reply] "The usual healing period is total 2 months so after this period it is okay to take any surgery. To make it safe, please inform Dr.Kim of this during your consultation regarding the surgery procedure and etc."

-A