Yeson - coughing/clearing throat

[Dana88]

So I had my VFS at Yeson on Monday. I've been trying to do everything like I'm supposed to, but I'm having a really hard time with the coughing/clearing your throat aspect. I find sometimes with expectorants that they loosen things up to the point where I feel like I have a ton of mucus sitting in my chest but not enough that they help much. So they sometimes end up being counterintuitive as a cough suppressant because the amount of phlegm I feel like is building up in my chest makes it feel like I constantly need to clear my throat or cough it up. Then add on top of that my concerns that I'm gonna make myself sick between the amount of mucus sitting in my chest + getting on a super long flight soon + caffeine withdrawal. Anyone who went to Yeson struggle with any of this?

[Laura_7]

Well some people inhale the scent of a warm tea, for example...
and there are inhalation procedures with warm water in a bowl, and your head above it, covered by a towel...
it helps to clear the throat...

talk it all through with your doc beforehand...


hugs

[iKate]

I grinned and bore it for 2 weeks. I coughed about 3 or 4 times total and they were very light. Even now I do my best to avoid coughing and I'm almost 3 weeks post op.

Every time I felt I needed to cough I would open my mouth wide and go "ahhhhhhhhhhh" a few times letting air escape. Not phonating just pushing out the air gently. A few times and the urge to cough went away. A couple times I was caught off guard and I coughed but my follow up showed a good heal. Once I coughed up a speck of blood a day or two post op and I was so scared. But my post op exam showed nothing was wrong.

Drinking lots of water seemed to help too. The phlegm went away or came up on its own.

The long flight was no issue for me but I flew prestige class on Korean Air direct to JFK so I had better sleeping quarters than coach and better food.

[Dana88]

I grinned and bore it for 2 weeks. I coughed about 3 or 4 times total and they were very light. Even now I do my best to avoid coughing and I'm almost 3 weeks post op.

Every time I felt I needed to cough I would open my mouth wide and go "ahhhhhhhhhhh" a few times letting air escape. Not phonating just pushing out the air gently. A few times and the urge to cough went away. A couple times I was caught off guard and I coughed but my follow up showed a good heal. Once I coughed up a speck of blood a day or two post op and I was so scared. But my post op exam showed nothing was wrong.

Drinking lots of water seemed to help too. The phlegm went away or came up on its own.

The long flight was no issue for me but I flew prestige class on Korean Air direct to JFK so I had better sleeping quarters than coach and better food.

I am flying also Korean Air to JFK but in coach. On my way here it dried out my cords BAD. So that's something I'm worried about. And good. I haven't coughed at all, but I have done the "ahhhh" let air escape thing, and sometimes no matter how hard I try, some phlegm comes up and I instinctually clear my throat and phonate just a little bit. But good to know that you even coughed and coughed up a little blood at that and your postop checkup was still okay.

[iKate]

Yeah one or two coughs aren't going to cause an issue. Lots of people who had the surgery coughed and they are just fine.

[Dana88]

Yeah one or two coughs aren't going to cause an issue. Lots of people who had the surgery coughed and they are just fine.

And of course when I was doing the ahhhh thing, I accidentally phonated "ah" for a second. Oy. Add that to the list of anxieties.

[kwala]

Question for those of you have undergone surgery, what do they say about hard swallowing?  When I feel phlegm and need to clear my throat I can usually avoid it by taking a gulp-like swallow
  Is there any mention of avoiding that in your aftercare instructions?

[Dana88]

Yeah one or two coughs aren't going to cause an issue. Lots of people who had the surgery coughed and they are just fine.

And now I was half asleep and my brother did something and I without thinking in a half asleep haze said four words. We immediately called Jessie and she said if I had ruptured anything I would immediately have a severe sore throat and be coughing up blood, neither of which happened. She also said, while the surgical site is small and delicate, that they've had people cough, sneeze, accidentally talk in their sleep etc. and so far no one has ruptured. That said, I'm now a ball of anxiety that can't sleep.

[iKate]

Day 3 post op Mom woke me up to ask me something and I said "no" and I was startled. But nothing bad happened. I think only one person managed to rip the suture and she was basically shouting something.

[Laura_7]

And now I was half asleep and my brother did something and I without thinking in a half asleep haze said four words. We immediately called Jessie and she said if I had ruptured anything I would immediately have a severe sore throat and be coughing up blood, neither of which happened. She also said, while the surgical site is small and delicate, that they've had people cough, sneeze, accidentally talk in their sleep etc. and so far no one has ruptured. That said, I'm now a ball of anxiety that can't sleep.

Just relax... all will be fine 


hugs

[Dana88]

Day 3 post op Mom woke me up to ask me something and I said "no" and I was startled. But nothing bad happened. I think only one person managed to rip the suture and she was basically shouting something.

Yeah. Well luckily I woke up without a sore throat or any of the severe pain Jessie describes would have happened had I torn a suture. She said it would happen immediately, but still I was worried that it would creep up on me overnight. So I feel a little better. I'll feel way better tomorrow after my post-op if ::knockonwood:: everything is healing well.

[anjaq]

Its ok...

Everyone had these moments. I think no one made ith through that week without coughing or saying a word or two accidentially. Everyone has to clear the throat, the task there is to do it as gently as possible with the "hhh"-exhalation cough and then swallowing, drinking lots of water. For the nights I also had a strong cough suppressant.

The only thing I am not sure about is - I know that it is very hard to really rupture the suture, so that should not happen with some coughs or words. But how the coughing or talking affects the healing and scar formation is a mytery to me. I believe it does make a difference, but it is more a gradual one. I cannot really say though. I know that my lowest pitch is quite low now despite the 40% suture I can still reach A2, my average pitch is in the lower female range - and I had several issues, the main one was I coughed until I was blue in the face while not even being awake after anaesthesia - and then I said 3 words the next day in half sleep. I dont know if these are connected or not. Jessie tells me it is all fine, that I just need patience and do my exercises - now 5 months post op , the suture looks great and well healed... so I certainly did not damage anything big at the suture by those incidents... and definitely my "surprise phonation pitch" is a lot higher now - so I dont think I did not get the pitch increase - its just a matter of regaining muscle control and using it right which makes my voice not so perfect right now (except that low end in pitch - I am puzzled how I can still do A2 or even a half note below that)

[Dana88]

Its ok...

Everyone had these moments. I think no one made ith through that week without coughing or saying a word or two accidentially. Everyone has to clear the throat, the task there is to do it as gently as possible with the "hhh"-exhalation cough and then swallowing, drinking lots of water. For the nights I also had a strong cough suppressant.

The only thing I am not sure about is - I know that it is very hard to really rupture the suture, so that should not happen with some coughs or words. But how the coughing or talking affects the healing and scar formation is a mytery to me. I believe it does make a difference, but it is more a gradual one. I cannot really say though. I know that my lowest pitch is quite low now despite the 40% suture I can still reach A2, my average pitch is in the lower female range - and I had several issues, the main one was I coughed until I was blue in the face while not even being awake after anaesthesia - and then I said 3 words the next day in half sleep. I dont know if these are connected or not. Jessie tells me it is all fine, that I just need patience and do my exercises - now 5 months post op , the suture looks great and well healed... so I certainly did not damage anything big at the suture by those incidents... and definitely my "surprise phonation pitch" is a lot higher now - so I dont think I did not get the pitch increase - its just a matter of regaining muscle control and using it right which makes my voice not so perfect right now (except that low end in pitch - I am puzzled how I can still do A2 or even a half note below that)

Yeah, apparently I spoke quite a bit when I first woke up. My brother was there and was totally freaked on my behalf, but Jessie told him it's okay and that everyone coughs or talks when they first wake up while they're still out of it. When Dr. Kim checked the surgical site after the surgery, before discharging me, he said everything looked great, and from what I could tell as a layman it def looked as to be expected.

*So far* I've managed not to cough at all, but I'm only four days in so I'm sure I will at some point. Sometimes when I do the "ahhhh" thing, some mucus comes up, and then I end up having no choice but to switch to some actual clearing my throat or else I have a glob of mucus stuck in there. Though when I do that I've tried as hard as I can not to phonate while doing it. And then of course there was my four word oh ->-bleeped-<- moment last night haha. My postop is tomorrow, we'll see what he says. Hopefully all is well.

And that sounds a little crazy still being able to hit an A2. Can you hit all the notes on the way down there or is that a random low note you can hit? Also can I ask, what was your fundamental frequency preop/did you have any major tremor or assymetry issues?

[iKate]

The only thing I am not sure about is - I know that it is very hard to really rupture the suture, so that should not happen with some coughs or words. But how the coughing or talking affects the healing and scar formation is a mytery to me. I believe it does make a difference, but it is more a gradual one. I cannot really say though.

Dr Kim explained to me that the 7 days will complete the external healing but over the month it will complete the internal healing. He said the instructions said 1-2 words a day but it is better if I remain silent for the whole month as to not affect internal healing. I have been doing my best and anything I've said has not been loud. I spoke maybe 4-5 words total since I came back. I have coughed a few times but not many. I got extra Synatura to take home and that has helped.

I have no idea what it was like waking up from the surgery but all I remember is waking up in the recovery room and shivering. Maybe I coughed, maybe I didn't. I strongly suspect I did but I did not feel much of a sore throat when I woke up. The follow up showed the healing was pretty good though.

[iKate]

This my pre-op data if you're interested.

Low "normal" voice:

High "trained" voice:

[anjaq]

And that sounds a little crazy still being able to hit an A2. Can you hit all the notes on the way down there or is that a random low note you can hit? Also can I ask, what was your fundamental frequency preop/did you have any major tremor or assymetry issues?

Yes i had vocal tremor, probably from changing my voice deliberately for 17 years. I also had asymmetry, which was better at 8 weeks post OP but was worse again at the 4 month checkup. Dr Kim determined my fundamental frequency at 134 Hz, which is about a C3. The lowest I could hit at all pre OP was E2. But that took effort. Personally, I think my f0 was more like 110 Hz so about the A2 , but it's unclear because I did not use my original voice in over a decade. My average pitch in the readings for the voice analysis now seems to be about F3, sometimes it's G3. If I take the 110 Hz as a reference, this would fit to the expected increase of 75 Hz. If I take Dr Kim's analysis, I am not there yet, he predicted I would be A3 on average.

[Dana88]

This my pre-op data if you're interested.

Low "normal" voice:

High "trained" voice:

Yeah I was in a similar place to you. My "low voice" was 152 and my "high voice" was 191. I suspect that generally I am actually a little higher. I was a little under the weather on the day of the preop.

Also, odd question, do you by any chance see Zil Goldstein at Beth Israel for your HRT? When I told her I was doing this she said she had one other patient doing it who was getting there a little before me. So the fact that the timing makes sense and you said you were flying back to JFK, I figured I'd ask :-P.

[Dana88]

Yes i had vocal tremor, probably from changing my voice deliberately for 17 years. I also had asymmetry, which was better at 8 weeks post OP but was worse again at the 4 month checkup. Dr Kim determined my fundamental frequency at 134 Hz, which is about a C3. The lowest I could hit at all pre OP was E2. But that took effort. Personally, I think my f0 was more like 110 Hz so about the A2 , but it's unclear because I did not use my original voice in over a decade. My average pitch in the readings for the voice analysis now seems to be about F3, sometimes it's G3. If I take the 110 Hz as a reference, this would fit to the expected increase of 75 Hz. If I take Dr Kim's analysis, I am not there yet, he predicted I would be A3 on average.

Got it. Can I ask an off topic question? I've assumed after the four weeks of silence, when you start speaking again that your voice will be weak and a bit more difficult to use and navigate/will tire way more easily at first and that I'll need to be careful not to overexert. But I realized I don't actually know this, it's completely based on assumption on my part.

[iKate]

Also, odd question, do you by any chance see Zil Goldstein at Beth Israel for your HRT? When I told her I was doing this she said she had one other patient doing it who was getting there a little before me. So the fact that the timing makes sense and you said you were flying back to JFK, I figured I'd ask :-P.

Yes I do. She's awesome. And it's pretty safe to assume it was me she was talking about. I saw her last week in fact for a postop checkup. Zil does my primary care too.

If you're in the city sometime I would love to meet up if you're so inclined.

[Dana88]

Yes I do. She's awesome. And it's pretty safe to assume it was me she was talking about. I saw her last week in fact for a postop checkup. Zil does my primary care too.

If you're in the city sometime I would love to meet up if you're so inclined.

Yeah, I love her! I switched to her after working with an endo that ended up really not seeming to know what he was doing. I went to her for a second opinion and she stuck. And sure! I'll PM you my email later today and we can figure out when :-). I'm always happy to meet other trans ladies in my area!