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Post VFS and intubation

Started by thegreenrabbit, May 08, 2015, 02:56:02 PM

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thegreenrabbit

Has anybody had surgery post VFS? How did they deal with intubation? One thing is what the clinics tell you, but what are peoples experiences of this? I know of one CTA patient who had her vocal cords damaged by it.
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Eva

I had a 6-7 hour FFS with Dr Spiegel 3 months after web glottoplasty with Dr Haben...  Spiegel is an ENT as well as FFS surgeon though... It wasn't an issue at all for me ;)
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anjaq

I think FFS surgeons are more careful about this than others. FacialTeam for example know about the glottoplasty VFS procedures (like Yeson) and take special care of this.

I would be more worried in non trans related surgeries later on - like breaking a bone, being in an accident, having heart issues or whatever. I think as long as its a planned surgery in some way, one hopefully can negotiate with the  anaesthesist about what to do and what not to do. In case of an accident, it gets tough.

Actually since Greenrabbit and me talked about this today elsewhere ;) - I think I will design an emergency card (either just laminated printout or actually a plastic card) that goes into my wallet and also into my car. I plan to include a warning, a short description of the changes of my vocal folds and a short description of what to do and what not to do in case of an emergency intubation. The same thing is availabe for people who have other issues that have to be taken care of in emergencies, like allergies to antibiotics, heart issues, ... - as I understand it, EMTs are taught to first look into the wallet for such cards before they do their treatments.

Does anyone know what I should write down there? Has anyone gotten clear and "official" information yet on what to do and what not to do in such a case? All I know so far is: use a small intubator, ideally one for children and insert it carefully.

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Cristal Muso

I personally think that wondering if an intubation may damage the vocal chords that has been surgically shorten, is in fact a wrong question for a non existent problem.

The last 80 years history of body part transplants coming from the individual himself or herself also called auto graft, has shown that once it's connected, it's connected. For the grafts or broken bones once they are repaired, are actually more stronger than before (to be short over production of calcium, to fix the injury)

For the soft tissus, flesh tendons and so on, the healing process is slower than the bones (that's why for every surgery performed anywhere on the body, the complete stabilisation is set between 6 to 10 months depending on the individual ), but the "soldering " of the 2 or multiple parts that has been put together, the cells, the tissus are so bind together on the cell level, that there's nothing to worry about.

Thinking logically why Dr Kim is using a permanent suture, where other surgeon or Professor (Remacle) are not, can be justified to insure him (and the patient) a plain and radical solution to make his surgery successful with little hassles post op (i.e people starting talking to soon, or other issues) remember that Dr Kim has an expertise yes, but he's a business man too, so every potential problems he may have has to be avoided. Having said that,  there's no justification after the 1/3 of the vocal chord has been soldered, that any issues may rise.

Many athletes have had a broken ligament or tendons, and after surgery and recovery period and re education (sounds familiar?) they can resume their very demanding physical activities, there is NO reason that the vocal chords are any different, and couldn't bear an intubation

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thegreenrabbit

All sounds good until the day that an anthesiust trys to use an oversized intubation based on what he sees. In an emergency you may not be capable of informing them about the glottoplasty. All situations are theoretical until it happens.
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anjaq

Quote[starting?] 2 months after VFS surgery, you can receive other surgeries under general anesthesia but at this time the doctor should use a smaller endotracheal tube size of #5.5 to avoid any damage on the sutured points. In case this cannot be met and your surgical portion should be damaged, you may have to go through the VFS procedure again

This is what Yeson clinic wrote me before the surgery when I asked about surgeries after the procedure...

So it seems imporant to reall use the smaller size tube. And it makes sense - the opening for the tube is smaller now, because 1/3 of the diameter is basically blocked by the flap that was created in the surgery. So the outer diameter does not match the inner diameter anymore and apparently doctors, EMT, surgeons will judge the size of intubator needed on the size of the larynx. If they do, they would use a tube that is as large as the trachea, but too large for the reduced opening of the vocal folds.

According to a surgeon I talked to yesterday (who was in many aspects very much hurtful though, so I dont really value what he says about this too high, but it still seems he has seen that), if this happens, the voice can be damaged severely because part of the suture can be re-opened.

A friend of mine had her suture ripped open because she was screaming within the first 2 weeks post op and her voice after that was lower and more rough than her pre op voice. She struggled to get close to her pre op trained voice, I believe. She had to get another surgery.

So I never want this to happen to me, I really think following Yesons instructions in that point as well totally makes sense...

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thegreenrabbit

#6
Seems that irony and fate have teemed up against me to try this at first hand. I am 6 weeks post and was rushed to hospital last night with acute appendicitis. They used the smallest tube they had, and she tells me that it apparently but that that the biggest problem.Was removing.the tube.
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anjaq

Oh dang!   :o . This sucks. I hope all went well and your voice is fine. 6 weeks should already be rather ok, after 8 weeks Yeson told me they allow surgeries, so 6 weeks is almost there. Glad you could tell them about the small tube and that they did that and it worked. I can imagine pulling it out is not easy because of the blockade at the glottis area. I guess this would have been even harder with a larger intubator? But it seems they were careful and not just pulling and thereby doing some damage... phew.

I wish you a good recovery. Rest your voice. I would think, a total voice rest for a week or two is probably a good advice...  :-X

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thegreenrabbit

Quote from: anjaq on May 11, 2015, 05:57:11 AM
Oh dang!   :o . This sucks. I hope all went well and your voice is fine. 6 weeks should already be rather ok, after 8 weeks Yeson told me they allow surgeries, so 6 weeks is almost there. Glad you could tell them about the small tube and that they did that and it worked. I can imagine pulling it out is not easy because of the blockade at the glottis area. I guess this would have been even harder with a larger intubator? But it seems they were careful and not just pulling and thereby doing some damage... phew.

I wish you a good recovery. Rest your voice. I would think, a total voice rest for a week or two is probably a good advice...  :-X
I kept on at them constantly about the intubation tube, eventually they found one they would use for a child. Putting  it down was no problem because they used a camera. However used twice as long to ccarefully ease it out. So it's bout information. I've had to use my voice in a few instances, but have rested it for the rest of the day.
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anjaq

Yes, that is the recommendation Jessie gave me - to use one for children. Size 5.5. Good that they could use a camera to fit it in. I am not sure this is possible in all circumstances.
I am glad it all worked out for you!

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iKate

Quote from: anjaq on May 09, 2015, 02:50:17 PM
I think FFS surgeons are more careful about this than others. FacialTeam for example know about the glottoplasty VFS procedures (like Yeson) and take special care of this.

I would be more worried in non trans related surgeries later on - like breaking a bone, being in an accident, having heart issues or whatever. I think as long as its a planned surgery in some way, one hopefully can negotiate with the  anaesthesist about what to do and what not to do. In case of an accident, it gets tough.

Actually since Greenrabbit and me talked about this today elsewhere ;) - I think I will design an emergency card (either just laminated printout or actually a plastic card) that goes into my wallet and also into my car. I plan to include a warning, a short description of the changes of my vocal folds and a short description of what to do and what not to do in case of an emergency intubation. The same thing is availabe for people who have other issues that have to be taken care of in emergencies, like allergies to antibiotics, heart issues, ... - as I understand it, EMTs are taught to first look into the wallet for such cards before they do their treatments.

Does anyone know what I should write down there? Has anyone gotten clear and "official" information yet on what to do and what not to do in such a case? All I know so far is: use a small intubator, ideally one for children and insert it carefully.

I carry around a medical ID. Anyone with any issues or special note should. If you have an iPhone it is there in the health section and emergency responders (at least here in USA) know to look for it.

It lists my conditions, medication and contacts for my primary care doc.
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thegreenrabbit

I had an ENT examination today and was given the all clear. The web and stitches were still in place. I was still swollen due to having the intubation  tube down the throat, but now just a bit of swelling. A close call was that.😁 and I'm also minus my appendix.😍  but ....remember use a chilkd size intubation and keep hammering home why you need it.
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anjaq

Good to hear all is ok, I would suggest to rest the voice a lot if there is swelling from the intubation and also contact Remarcle about it. The swelling should go down before you use your voice regularly again. The suture is still not fully healed, so swelling may impede the healing process...

I wonder if that child size intubators should be used in the future always by us, or if it is only critical during the healing period

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thegreenrabbit

Quote from: anjaq on May 12, 2015, 08:01:50 AM
Good to hear all is ok, I would suggest to rest the voice a lot if there is swelling from the intubation and also contact Remarcle about it. The swelling should go down before you use your voice regularly again. The suture is still not fully healed, so swelling may impede the healing process...

I wonder if that child size intubators should be used in the future always by us, or if it is only critical during the healing period
The. I would definitely use the child size and err on the side of caution. If you ask for that it also shows that you know what your talking about when talking it through with an anaesthetist. Because I could feel that they were a bit on uncharted ground. Been there and done that.
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thegreenrabbit

Reading through my journal I can see that they used a size 6 tube. The ENT on call recommended a 2 weeks silence based on the bruising, and could see that the stitches and glue were still in tact. Which is amazing  when it's now nearly 6.5 weeks postop. Will be a few weeks before I am fully back on my feet.
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