Yeson - Jul 22-30

[northcountrymassage]

Jessray,, functional would mean that you have some sort of damage/abnormality with your voice box/vocal chords which from everything I heard you do not.  Unfortunately your crappy roll of the dice gave you a problem with your nervous system (hence physical from my understanding).  Kinda like functional would be weak muscles that could be strengthened with exercise and physical would be the nerves being somehow damaged making it very hard to control the muscles.

[anjaq]

I am not sure about the "functional" definition in this case. My diagnosis was "functional dysphonia" which basically meant that my voice function is inpaired, as I understand it. It is to my understanding nothing that cannot be treated with therapy. However I do not know about SD.
My personal approach would probably be: Get the diagnosis confirmed and specified (there are several types). Get voice therapy or rehab to learn how to compensate at all pitches, not just at an elevated pitch. (My guess is that this should be possible as you probably did not have a breaking voice forever until you feminized your voice?). Check your hormone balance. Several hormoned and medication can influence conditions that are connected to voice and neurological issues. Spiro for example is known to act on the voice. Progesterone acts in part on the voice and is a neuroprotecive and neuroregenerative agent. Testosterone is important for muscle activity and also nerves and bloodflow. Sadly for some, the goal in HT seems to be to just up Estradiol and lower T as much as possible and forget about P. I know from personal experience that his is a bad idea. I cannot even exclude that part of my voice regeneration in the past year is because I discovered my hormone imbalance.
Maybe try all of these options and then see if you need and want VFS in a year? Its not the most pleasant news, I can imagine. I am sad for you. I hope you can get it better.

[Jessray]

I don't (think I) have a breaking voice now, and I certainly did not pre-feminization training either, yup. I just don't talk much period since I tend to clam up outside of 1 on 1 social settings.

But yeah. I am on all 3 meds. I haven't emailed the voice clinic still but probably will over the next couple days once I pull myself together cause I know they have yet another queue as well (And I'm not sure how much it will cost if anything).

Being able to now get back on my medication is definitely a small plus point in this mess though.

Thanks for the well wishes again. I'll weigh my options down the road for sure, but if it involves any sort of long term botox treatment then I probably will just stick with what I have and let this dream die.

[anjaq]

Well, if your voice is naturally in the neutral range without any training, you could maybe get it feminized with training alone, in case surgery is not for you.

About the meds - please remove the dosage numbers ! -  I think having Spiro and then dropping this pre surgery may increase issues. Make sure to get enough Progestereone if you have too little -it should be well above what women get for menopausal issues. Blood levels should be well above 2 ng/ml. Estradiol tablets also have issues. But this is off topic. I just cane to it because I read some scientific articles showing that Progesterone has a significant effect on nerves and if the SD is a neuronal issue, it may be lessened by increasing the P dosage.

[Jessray]

Hello! Sorry for bumping a really, really old thread, but hey, it's my thread.

I just wanted to give a minor update to tie off the thread in case any other people happen to stumble upon this thread in future searches; I did a year of research and planning, saw a couple EMTs in town (all of which said I clearly did not have SD), and looking into what resources I had here in the city (Edmonton, Alberta) and where I would go if I needed Botox injections post-op. So after talking to Yeson, I decided to go back to them again for their VFS with a friend accompanying me this time, a year and three months or so after my last failed visit.

This time it all went smoothly, Dr. Kim claimed that my tremors, condition etc had gotten a bit worse, but that the surgery would help with the uneven vocal folds and such. He didn't even really stress the (alleged) Spasmodic Dysphonia this time in the diagnosis, and counter to the last time, said that this time he expected a full recovery and success as long as I followed the regimen and training and a possible followup Botox jab here if needed (review after 2 or 4 months?). I guess the big difference between the last trip and this one was simply the planning and knowing my support group and options back home for post-op care. They asked me if I had done any training during the year and I said no, but I knew where to go and whom to ask if I needed any post-op. They seemed to be satisfied with that. Dr. Kim also didn't think I would need more than one, maybe two, Botox injections post-op, but hard to predict the future of course.

Anyway the deed is done now, I had it done Oct 21 so I'm 2.5 weeks post-op, it's been 1 week since I arrived home, and I still can't believe I went through it and even had someone there for support. Dr. Kim prescribed me some extra medicine cause there was still some swelling during the post-op checkup, but all that's gone now, so is the swelling and sore throat though. The most annoying part far and away is/was the 30 minute period after a meal where I'd fight phlegm and the urge to cough, ewww. All my voice restrictrion violations have been due to minor unavoidable coughs from this.

The Botox injection left a nasty dark bruise on the neck but that's mostly faded now, still slightly visible in good light though. I do have my some sort of a voice back so that's a (perhaps silly) relief as I was not sure after the last trip's conversations with Dr. Kim, my voice for the one or two words I have said has been a bit softer/weaker, but steady. But I have not quite tested it as I plan to use all my "daily 1-2 words" only on coughs for now.

We stayed at Seocho Artnouveau City this time (Artnouveau City III, as opposed to Gangnam Artnouveau City/AC II last time). I'd say it was a clearly inferior experience, but not entirely bad all things considering. We ordered food from a different restaurant for every single meal we had, both eat-in and take-out, it was no real big deal at all with a tablet and internet access to do Google Translate with.

The price of the operation was exactly the same; most of the procedures and pre-op and schedules and stuff are still the same, there were a couple minor differences like having to send them a voice file before they would approve the op, as well as sign a form saying I would not disparage them offline or online no matter the outcome (but I really don't have anything bad to say right now anyway, the staff was fantastic and I think I will be just fine).

I miss Seoul already. Grrr.

[Meiguishui8]

Hey Jessray, how did everything turn out?

I'm in Seoul and ran into pretty much the exact situation you did. I also decided not to go through with it, though am considering changing my mind. Kind of at a loss. I hope all is well!

[Jessray]

Hi! You are in Seoul right now? Eep, good luck whichever way you choose to go! What did the doc say?

Mine actually turned out well in a recovery sense so far, I still have a little bit of cutting out or shakiness in certain parts of my middle voice range, hoping that will clear up over time. My lower range is fine and the minimum pitch has been raised a little, my upper range is also doing great and I can hit much higher notes much more comfortably than before, though my normal speaking voice for now still rests close to/just a bit above the original speaking voice. It takes less effort to remain there now though and I can go even higher.

I had itchiness in the throat right at the 4 month period just as they had predicted, but I did not go for a 2nd Botox jab as it subsided after a week or so and lots of water and a few of those pills that they had prescribed. Unsure if that was the right solution or not, and I think Botox may even help with that little bit of shakiness in the middle range, but we'll see.

Edit: He said that stuff about me taking 6 times the normal air that a person does to vocalize words and sounds, though I didn't feel it then. I still don't really feel the difference now though I'll trust his judgement on that (even though my docs at home said nothing was wrong). The surgery supposedly does fix all that too though, as a side effect.

[Meiguishui8]

That is great :-)

When you 'original voice' are you referring to your trained voice before surgery?  Like, now post-VFS you can sound that way with no effort?  I would love to just open my mouth without a thought to what sound might come out. 

I'm considering to do as you did and treat with the botox first and have the surgery in a few months.  How did the botox without surgery affect your voice in the meantime?  Does it also render you unable to speak?  I'm concerned also that the botox might make my voice unpassable.  This would greatly affect my safety and livelhood, so I am a little scared about that, and the whole choking on water thing.  I wrote to Jessie about this and hopefully will hear back after the weekend.

**oh yes, I forgot to answer: the doctor said I have asymmetrical cords plus a vocal tremor.  He said my cords were relatively gender neutral as was my without effort fundamental frequency, but that my trained (straining) voice was within the female range.  He suggested I delay the surgery and treat the tremor with botox in the meantime.  But he left the decision up to me which was incredibly hard, as I'd come all the way here and planned two months off of life.  I also cancelled the surgery but haven't done the botox yet, still trying to figure stuff out.  I could still do the surgery a week from now but I think maybe I should heed his advice.  It's a lot of new information to take in...

[Jessray]

I did not do botox until after the surgery from Dr. Kim, I went to a couple EMT doctors here back home in the intervening year and they swore up and down I didn't have the spasmodic dysphonia that he said I had. So they wouldn't give me botox anyway. He almost certainly overdiagnoses the vocal tremors/asymmetrical cords thing, and said I had those too, though they're definitely there to some degree and that doesn't necessarily mean you don't have whatever he says you may have.

I used the year between my two visits to scout out where I would have to go if it turned out I needed botox injections, find out how much it would cost, get to know a couple EMT doctors and someone at the local voice clinic whom I could set appointments through and such. But I was pretty much the same the year after, I just had more information and had went into and came out of depression a little stronger.

Re the original voice, I was referring to trained voice before surgery, yes. I still think mine could be better heh.. I feel like I haven't found my best natural pitch to settle on yet, but I really like the higher range and less effort overall. It doesn't feel like there's a lump blocking my throat if I try to hit or sing high squeaky pitches now.

I can't say one way or the other that you should go through it or should put it off though, that's a decision you have to make, but I doubt most docs will even give you botox just by you asking for it or claiming tremors.. at least mine wouldn't, even with the SD diagnosis because they found no sign of it.

[Denjin]

Meiguishui - Dr. Kim told me that it's 1% who have problems like not being able to swallow water after the botox.  I had my shot like 5 days ago and haven't that that problem yet.

Jess is right about him just about always finding a tremor.  I bet most people have a slight one?  You can tell if you have one by recording yourself making 'ahh' sound for long long time (keep the pitch constant).  If you have a tremor, it will waver at some point and come back.  Mine did that about every 5 seconds and was worse at lower pitches.

[anjaq]

Amy managed to get Dr Kim to not do Botox on her - she is a trained singer, so the first time she did the normal "aaahhh" thingy with him and he diagnosed vocal tremor. She asked if she may repeat that test, concentrated on not allowing vibrato or impurities in her voice and that time he did not see any tremor. So I guess what he sees is just a rather natural pitch variation that most people have who are not trained singers and concentrate on it in that test. Of course in trans people it will be more, because the voice use is often different for some time already, putting more strain on the voice, causing it generally to be more stressed and strained.

[Meiguishui8]

Thanks girls. I really think if I went in and tried again on a better day he little to no tremor.  I also suspect my asymmetry might be related to my jaw asymmetry (same side) but maybe just might have to do with alignment.  Perhaps I can get a chiropractic adjustment or do some yoga and have things pop back into place. I mean I wonder if they are actually different sized or one is just stretched longer than the other from bad alignment. 

We will see.  I really don't want to do the botox unless its really necessary, and it seems to me I should take his diagnoses with a grain of salt.  That is not quite the approach I'd want to have to take with a surgeon operating on my throat but that's life.  However now, since all this has happened, I'm not even sure I'm ready for VFS to be honest.  I want it of course, I feel I need it but now I'm considering other things might be more important for now.  I think I may need to get my depression and hormones under control before going through such a challenging recovery.  This may require going back to the US (I live in Asia) in order to find a proper HRT doctor who knows what they're doing.  Since living out here I had to switch to pills after years of injectables and I've been miserable.  But that's for another thread.