Post VFS Thoughts

[Rachel]

I had a cricoid thyroid subluxation 12/2017. It raised my voice from 135 Hz to 175 HZ. My range was 175 to 190 HZ.

I then had a glottoplasty on May 15, 2018. I am almost 6 months post op. My pitch is 275 HZ and hoarse and have low vocal power. I do not sound male. My vocal power is improving slowly. I think the hoarseness has improves very little in the past 30 days.

I saw the doctor a week ago and he said that he could take down the web a little in the office if the hz does not come down by itself. It was in the 360 hz range a few months ago. He said the hoarseness will improve over the next 6 months.

Next week I will have a 24 hour acid reflux test by real time monitoring as I do my normal routine. It will show if the growth in my one vocal fold is from reflux or from healing. If from healing he will remove it in the office.

I believe the growth behind the one vocal fold is causing the distortion in the vocal fold and causing the hoarse voice.

If the vocal fold distortion from the growth is removed I believe the hoarseness will go away. I believe the HZ will most likely end up at 250HZ May 2019. When the voice hoarseness is gone then I believe I will have  increased vocal strength.

My web is high and I estimate it to be 60%. The web looks beautiful as does the work.

Lessons learned for me is patience. Also, the doctor I am going to is very good and I trust him. Lastly he has my best interest at heart and wants a great outcome. He told me that if he made the web lower then he could not adjust the patch higher in a year when my voice settles and he can adjust the web lower in his office if I want that in the future.

[Northern Star Girl]

@Rachel
Dear Rachel:
Very interesting update regarding your trials and tribulations with your voice pitch, hoarseness, GURD Acid Reflux, and other matters pertaining to achieving your goal of a convincing female voice....

Please, if you feel so led, to keep us all updated with your healing and your voice progess.
Thank you for your update and for posting your thoughts.   

Hugs and as always, well wishes for you.
Danielle

[HappyMoni]

Considering all the stress this has put you through Rach, do you feel it was worth it? Do you wish you hadn't done either surgery? It scares the hell out of me, and I've had my share of surgeries.

[Rachel]

Hello Danielle, I will definitely share my experience and outcome and thank you for the kind words.

Monica, FYI, I definitely voted

I have thought of this many times. Would I do it again?

I wonder what the outcome would have been if I kept my scheduled glottoplasty with Dr. Haban?

I never would have been able to afford Dr. Sataloff if he was not in network and the hospital in network and covered by insurance. The cricoid thyroid subluxation was reimbursed $62,000 and the glottoplasty $74,000.

Should I have gone to Dr. Kim and paid $12,000 and visited Korea?

I think if a patient had a good outcome then it does not matter who they went to for the surgery. If a person has a bad outcome then the surgeon is at fault and if it is mixed results then the surgeon is not that good. The reality is there are many factors and age and past smoking may have played a part.

I need to give the operation one year to fully heal and I need to find out if I have reflux ( I am on meds for it) or just a healing issue that can solve the problem.

I am lucky to have the experience and know how vocally impaired people are treated. I am positive I will have a good outcome. Sometimes the path to success is not a straight line.

To answer your question if I am to wish I wish I had a good outcome. If I had known the outcomes of these two surgeries then I would only choose Dr. Kim. However, I have heard that he has had bad outcomes too.

[Katie]

Vocal surgery for me was the icing on the cake. It was the last of all the surgeries and the opening door to being just any other girl...........

I cannot over state this. If someone is happy being a trans person in the eyes of the world then good for them. TO me I just wanted to be a girl...........

[kwala]

Hello Danielle, I will definitely share my experience and outcome and thank you for the kind words.

Monica, FYI, I definitely voted

I have thought of this many times. Would I do it again?

I wonder what the outcome would have been if I kept my scheduled glottoplasty with Dr. Haban?

I never would have been able to afford Dr. Sataloff if he was not in network and the hospital in network and covered by insurance. The cricoid thyroid subluxation was reimbursed $62,000 and the glottoplasty $74,000.

Should I have gone to Dr. Kim and paid $12,000 and visited Korea?

I think if a patient had a good outcome then it does not matter who they went to for the surgery. If a person has a bad outcome then the surgeon is at fault and if it is mixed results then the surgeon is not that good. The reality is there are many factors and age and past smoking may have played a part.

I need to give the operation one year to fully heal and I need to find out if I have reflux ( I am on meds for it) or just a healing issue that can solve the problem.

I am lucky to have the experience and know how vocally impaired people are treated. I am positive I will have a good outcome. Sometimes the path to success is not a straight line.

To answer your question if I am to wish I wish I had a good outcome. If I had known the outcomes of these two surgeries then I would only choose Dr. Kim. However, I have heard that he has had bad outcomes too.

Thanks for continuing to share your story!  I'm so sorry your results have had complications.  I totally feel your pain (I know you've read enough about my story over the years). I think it's really important to hear the full spectrum of results when it comes to voice surgery.

Don't give up though!  My voice is leaps and bounds better than it was over the last three years because I refused to accept the results and kept thinking outside the box, did tons of research and saw dozens of specialists before settling on a procedure that I felt had the best chance to decrease the problems. It's very stressful and a lot of work, but I am so glad I'm sticking with it. From 2015 to about six months ago I had basically become a shut-in and had given up on having a social life because my voice was so weak and sickly sounding it seemed futile. Since my surgery with Dr. Thomas, I can go out into the world again without fear.  I don't know if I'll ever be able to really scream again or belt out a Barbra Streisand song but I can now be heard in public and strangers have stopped asking me if I have a cold! I can even (sort of) sing if I keep it really soft. My voice is far from perfect but I'm so grateful to have regained even a small portion of what I had before.  So hang in there!  There are a lot of new procedures and injectible substances on the horizon for vocal cords that will probably be in every ent office within the next five to ten years.

[Rachel]

Hi Katie, I agree, I just want to blend in and be me. Where I work there are woman that are tall and some taller than me

Hi kwala, I read your story and followed your every step. I am glad you have partial restoration of your voice. From your troubles with your voice I had Dr. Thomas and your positive outcome from his work to keep as a next step.
______________________________________________________________________

Last week I had a few episodes where something happened with my voice I can only express to be like my voice change in puberty. Although, my pitch did not go down, my voice projected. It was off and on a few times a day. My vocal vibrations were "slower" in feel.

This week I can speak in that mode and it is getting smoother. It is becoming my voice. I can project my voice. It sounds very different in my head. I record my voice daily and it sounds very different than it did three weeks ago. My base is 208 to 230 HZ. I can go higher in pitch.

I was thinking. With my GCS and revision and all the work done down there I would listen to what Dr. McGinn would say. For example a few weeks ago she said my next revision surgery will be in April and that she wanted my vaginal skin to soften before she did another surgery. Well, it make sense that the vocal surgery would have made my structures in my throat less pliable. Everyone heals differently and perhaps my healing is still in progress.

Dr. Sataloff did say it will take up to a year to heal and that my HZ would go down. I am very cautiously optimistic. I will never be able to sing but I could not sing before. Being so incredibly scared I would have no voice or an very impaired voice I now have hope. If my voice continues to improve then I think I will be satisfied.

All I can say is be advised of the potential outcomes from VFS. I now appreciate my voice so much more than I did in the past. It has a huge impact on our lives. I am so very appreciative of regaining some vocal power. I have some hope now. Perhaps my doctor really is awesome.

My VFS doctor said the last time I was there the he too is impatient and that we just need to let nature takes its course. Perhaps I had huge expectations and I am impatient. I do know I am grateful to have some vocal power back.

Rachel

[Rachel]

It has been a few weeks since my last post on my voice. I record my voice each morning 5 days a week. I hear improvement every 3 or 4 days. My voice is smoother and I have a little more vocal power than last week.

In the last 3 weeks I have made significant vocal progress. I have a long way to go but I continue to hear progress as time goes by. At 6 months I was very discouraged. When 2 more weeks passed I thought my voice was never going to get better and I needed to see another doctor. My thoughts on my voice now verses then has turned 180 degrees and I am very happy to be able to talk and be heard. I think my voice will be good by the spring. I am around 220 HZ base voice.

[Northern Star Girl]

It has been a few weeks since my last post on my voice. I record my voice each morning 5 days a week. I hear improvement every 3 or 4 days. My voice is smoother and I have a little more vocal power than last week.

In the last 3 weeks I have made significant vocal progress. I have a long way to go but I continue to hear progress as time goes by. At 6 months I was very discouraged. When 2 more weeks passed I thought my voice was never going to get better and I needed to see another doctor. My thoughts on my voice now verses then has turned 180 degrees and I am very happy to be able to talk and be heard. I think my voice will be good by the spring. I am around 220 HZ base voice.

@Rachel
Dear Rachel:
Your good news update is great for me to read.  I am so very glad that you are making significant progress...
... I know that you were concerned and I was somewhat worried about possible complications when you first posted on this thread. 
Your update is most welcome to read for all of your readers and followers...

Thank you for sharing....
Hugs and more hugs,
Danielle

[Rachel]

Hi Danielle,

I had gone 6 months two weeks being very hoarse and of very low volume. Then 6 months 2 weeks and 1 day my voice "broke" like I all the sudden hit some milestone. I really think the scar tissue relaxed and the vocal folds touched and became more flexible.

It has been a month since my voice started to work again. I record my voice 5 days a week at the same time and say the same thing. I continue to notice my voice becoming smoother . My pitch varies depending on humidity or lack of humidity. I noticed when it is dry it goes higher to 240 HZ and when humid it is at 210 hz. I have noticed I am getting more words per breath now and that continues to improved. One of the things I do is count to 20 and I noticed I continue to count higher before a breath is needed.

[Rachel]

I saw my surgeon today. I am still hoarse. My voice is improving and I record it 5 days a week and listen to past recordings for comparison. Also I noticed my wave forms are changing in time in a very positive way.

The video of my vocal folds show one vocal folds vibrating well and compensating for the other vocal fold. The doctor mentioned he may inject the right vocal fold with a substance to make the vocal fold more flexible. My pitch is fine and the only issue is the one vocal fold is a stiffer than the other.   

[Rachel]

Hi, this is an update on my progress. I had a cricoidthiroid subluxation and later a glottoplasty. I do not recommend a CTS for several reasons. The glottoplasty was aggressive. I have a pic or two of my vocal folds on my thread about my transition and procedures.

The issue of the one vocal fold not moving and the other having edema and compensating has resolved itself. About 50% of the left and right vocal folds touch and vibrate in unison. The issue is the scar tissue has had to soften and as it softens and the area normalized my vocal folds are behaving more and more normal.

My HRZ without raising my pitch or a resting voice is 220 plus of minus 10 hz. I can raise my pitch very high with inflection to 350 to 400 hz. I am still getting clarity improvement with time. I can hear improvement every 2 weeks.

I suspect my vocal folds will eventually fully touch and vibrate 100%. The doctor is holding off in injecting the web area with a chemo drug used off label to soften the scar tissue as it has continued to soften and change.

What is really cool is the edges of the vocal folds look like my old vocal fold edges as they are very light in color. The web scar area continues to become incorporated into regular tissue.

I was not a singer to begin with and that has not changed. I still can not play the piano (joke). However, I think in time my voice will continue to improve to some point.

I was really afraid my voice would never improve. It has and continues to improve. I am 75% happy with the procedure and expect that will improve in time.

Funny as other say I sound female I still hear my old voice somewhere inside my new voice. Lighter and lighter pitch but similar. I am never gendered male on the phone. I do make a point to use inflection on the phone when answering. It sets the female perception in the listeners mind.

 

[Rachel]

June 6th I see my voice surgeon for a checkup and 13 month evaluation. It would have been about 13 months since my glottoplasty. About 50% on my vocal folds do not touch in the posterior.

I have a long and wide web. It has been getting flatter and "more normal in appearance" in time. Post op 3 months my vocal folds did not touch. 6 months I had a rankies edema (reason I have a voice) right fold and some vibration of the left fold. 9 months edema is gone and anterior of the folds vibrate. The web is noticeable smoother. The surrounding issue is more normal. The edges of the fold are the correct translucent color.

I an anxious to see the 12.5 month video and pics. There were two methods of closing the posterior of the folds. One was an injection of material and the other is an off label use of a chemo drug to break up the scar tissue and increase flexibility of the vocal folds.

It makes sense the poster folds are being held open due to an anterior web. I will push for the injection.

Second issue is the scar from the CTS ( I would never recommend this to anyone). I spoke to Dr. McGinn and I may pursue this. It would mean another surgery. I am way past wanting another surgery but the issue is real an not pretty.

[Rachel]

Hi, I went to a laryngologist and speech pathologist at Penn to have my vocal folds reviewed a few months ago. My vocal folds look good. I have some vocal fry. My HZ is 230 to 270.

So all in all I am done with my voice. I am 100% gendered female on the phone all the time. 

[LoriDee]

Awesome! I am certain it involved some work to get there.

I aspire to be properly gendered on the phone. My training starts this Friday!

[BlueJaye]

You are very brave, in my opinion. The idea of vocal surgery sounds scary and intimidating. I'm glad to hear that your results were ultimately rather good.