Struggling to speak: a personal view of Spasmodic Dysphonia

This week we take a look at a rare vocal disorder called Spasmodic Dysphonia. It can greatly effect your vocal cords, resulting in a strangled-sounding or hoarse voice. For some, it seems like they have lost their voice. It can be treated with a combination of speech therapy and Botox, but there is currently no cure.

My name is Mark and I am 36 years old. I have always relied heavily on my communication and people skills to get me ahead of everybody else. I never would have thought that I would struggle with something everybody takes for granted.

I can’t pinpoint the exact moment where my life changed but I know for a fact that it happened in early 2006 while I was working for the San Antonio Express News in their call center as a Customer Service Representative. I was struggling to speak and was hesitating with certain words and phrases. It was extremely embarrassing!

I kept asking myself: Why is this happening? Will it ever go away? Will I lose my voice? Could it be stress related? Is it psychological?

There were certain words and letters that I really struggled with. The letter “h” was the hardest for me and to this day still is. The opening phrase at the San Antonio Express News was: “Thank you for calling the San Antonio Express News, this is Mark, how can I help you?” Two “h” words! So, I changed this to: “Thank you for calling the San Antonio Express News, this is Mark, what can I do for you?” A simple change but this really helped me on the phones.

Despite my speech issues, I never got any complaints or questions from customers or co-workers who couldn’t understand me. I thought it would eventually go away, but it never did. It was getting more difficult every day for me to speak clearly and be understood and I was embarrassed.

On May 1, 2006, I saw Dr. Yvonne Page, a Speech Language Pathologist.

As I soon started talking, Dr. Page knew exactly what I had. She asked me a lot of questions trying to pinpoint my problems and took a lot of notes. She eventually had me read these phrases: “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and "He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy's house."

I read the first with ease but really struggled with the second sentence.

Dr. Page referred me to Dr. Blake Simpson, an Otolaryngologist, who works at the University of Texas Health Science Center. He would be able to get a better look at my vocal cords and verify my speech problems.

Dr. Simpson also wanted me to read those phrases. With the second phrase, it felt as if I forgot how to read. I couldn’t even say the word “house.” My mouth opened but nothing came out. It took a few seconds for the word “house” to finally come out and it didn’t sound good at all. By using a fiber optic Laryngoscopy, Dr. Simpson showed me what was happening with my vocal cords.

In May of 2006, I was officially diagnosed with a rare voice disorder called Abductor Spasmodic Dysphonia. According to the Dysphonia website:

Spasmodic dysphonia (SD), a focal form of Dystonia, is a neurological voice disorder that involves involuntary "spasms" of the vocal cords causing interruptions of speech and affecting the voice quality. SD can cause the voice to break up or to have a tight, strained, or strangled quality. There is no cure. It is treatable by speech therapy and Botox injections in the vocal cords.

I started speech therapy with Dr. Page immediately after I was diagnosed. Our sessions were weekly for 12 weeks. For the first four weeks, we met twice a week. I was very lucky that my work schedule allowed me to have two consecutive days off during the week. Otherwise, I would have had to use all of my sick and vacation time.

We did a lot of breathing and relaxation exercises. We worked on the voiceless sounds. Every few weeks we would try words that began with the letter “h.” Dr. Page wanted me to have a soft voice; no yelling or talking loud on the phones. She had software that measured how loud my voice was and how much roughness I had. It was really interesting to see these changes before, during, and after a session. I was also able to hear my voice; it was good sometimes, bad sometimes, and sometimes just plain laughable!

I was relieved that the Speech Language Pathologist knew what I had as soon as I started talking.  Unlike other people I have met with Spasmodic Dysphonia, I didn't have to wait months or years and see several other doctors to get the correct diagnosis.  After lots of research, talking with Dr. Page and Dr. Simpson, and consulting with my parents, I decided to try the Botox injections. I was aware there could be side effects. But I was ready to take the plunge.

On August 14, 2006, I was in the waiting room at University Hospital in San Antonio, Texas. I was extremely nervous.  My mother came with me and her support really helped me get thru the anticipation of getting my first Botox injection.

Dr. Simpson sprayed my nose to numb it.  It didn't taste like anything, but it really made my nose runny!!  He then inserted a needle into my neck to numb it.  The numbing medication tasted really gross and made me cough a lot; but that means the numbing was working.  A Neurologist, Dr. Carlayne Jackson, put some sensors on my stomach; this helps locate the proper spot for injection.  A resident from the hospital was also in the room and he was the one who inserted the fiber optic Laryngoscope from my nose to my vocal cords.

I coughed a few times and said the letter "E" for a few seconds.  I even read these phrases again “Early one morning, a man and a woman were ambling along a 1-mile lane, running near Rainy Island Avenue” and "He saw half a shape mystically cross a simple path, at least 50 or 60 steps in front of his sister Kathy's house."  

Dr's. Simpson and Jackson located the correct spot for a unilateral injection and I didn't even feel the Botox. Wow!  Afterwards, I was coughing a lot, had some discomfort in swallowing, and my voice was very strained.  But, those side effects wore off quickly and I was very glad.

I went back for my 2nd Botox injection on October 23, 2006. I was more eager this time and was looking forward to how my voice would fare. It was the same procedure for the treatment. I had the same side effects but again they vanished quickly.

Since my diagnosis, I have had 17 Botox injections and I am getting fantastic results and do notice a HUGE difference in my voice.   I always have the discomfort in swallowing, a strained voice, and lots of coughing.  But, they go away quicker each time.  My last 3 Botox injections have lasted about 6 months. I will probably schedule another Botox injection toward the end of the year.  Each injection I get lasts longer than the previous.

If you heard me talk, you probably wouldn't even know I have any issues.  I do struggle at work occasionally but nobody notices it. I am kinda curious to see how my voice would do without Botox?

I made my first podcast to share recently.  I gotta admit, I was extremely nervous when I recorded this last night in my car on the way home from work.  Yes, my recording studio was my car; hey, it was quiet and nobody bothered me.

At least I thought it was quiet...when I replayed it afterwards, I heard my keys jiggling and my turn signal clicking.  Next time, I will unhook the car key from the miscellaneous keys and find a straight path to nowhere in particular.  Other than that, I am very excited  to debut my voice and hope you enjoy it.

This post was reproduced with permission from Mark at mdlblog.com. 

Children's Mental Health Awareness Day

Today we hear from Dr. Dan Powell, our soft-spoken and much-loved provider who mainly works at our Woodlake location. Here, he teaches us how to speak about mental illness without the stigma that's commonly associated.

Today is Children's Mental Health Awareness Day.  The National Federation of Families has declared this year's theme to be: "Out of the Shadows: Exposing Stigma."

As healthcare providers at Impact Urgent Care, we frequently have the privilege of providing care for children with mental health issues who present with acute illness.  While addressing the child's acute illness is paramount, an equally important issue (as with all children we treat) is addressing any associated family or parental concerns.  Without a doubt, one of the greatest challenges parents face when caring for their child with any mental health diagnosis is dealing with the stigma of mental illness.

Whether your child is struggling with Depression or Situational Anxiety, or more chronic conditions such as ADHD or Autism Spectrum Disorder/Aspergers, you are already well-aware of the overt and sometimes subtle ways that the stigma of mental health illness can impact a child and his or her ability to navigate the waters that other children breeze through at school or athletics, or even just going out to eat and going to the movie theater.  Reversing the stigma of childhood mental health illness will not happen overnight, but efforts are definitely underway to begin the process, and events such as Children's Mental Health Awareness Day are critical in raising public awareness and educating all of us on how we can make a difference.

The Hogg Foundation for Mental Health (www.hogg.utexas.edu) has produced a brochure titled Language Matters in Mental Health that gives excellent guidelines for HOW WE TALK about persons with a mental health condition.  Saying, "He has a mental health condition" instead of, "He's mentally ill" - or "She has Anorexia Nervosa" instead of, "She's an Anorexic" may seem like potato - po-tah-toe to folks who don't have (or live with a family member who has) a mental health condition but for those of us who do, it's a night-and-day difference that expresses volumes about a person's attitude toward mental health and/or the stigma of being labeled.  Educating your child's siblings, friends and teachers on the impact of the word choices we make when talking about a child with a mental health diagnosis is crucial to helping shape a healthy and encouraging environment for them to thrive.  This approach is called "people-first language" and can open up communication lines with others that take a concern for your child's well-being.

Caring for a child with mental health issues can be an enormous challenge for their parents, and we hope you will consider us a resource you can depend on at Impact Urgent Care.  We count it as a privilege.

Dr. Dan Powell

Dan Powell, M.D.

Staff Physician, Impact Urgent Care

Photo credit: alles-schlumpf / Foter.com / CC BY-NC-SA

Is it IBS or just tummy troubles?

You have a chronic condition that causes pain, occasional embarrassment and lifestyle restriction. Nobody really knows why or how you got it, though there are theories. There’s no cure, though the symptoms are treatable. Sometimes you can eat whatever you want, others even looking at something as innocent as white rice causes spasms.

It sounds dreadful, doesn’t it? Well, if you are one of these people, you may have IBS, or Irritable Bowel Syndrome.

For those who don’t have IBS, have you ever had food poisoning? Imagine that happening to you every day or even several times a month. The problem is that it’s not well understood. IBS can effect you either with diarrhea or constipation, and it’s estimated to effect 3-20% of the population. It’s a wide estimation because not everyone will seek medical help or even think they have a medical condition.

IBS can be treated in a variety of ways, including dietary, hypnosis, lifestyle changes, yoga, medications, therapy, etc. Some doctors will perform gastrointestinal scans to rule out other medical problems, while others will just write a prescription for an anti-spasmodic and allow you to go on your way.

Do you have IBS? How do you deal with your symptoms?

There are lots of resources out there to learn more about IBS and how to treat your symptoms. The US Department of Health and Human Services has a good overview. Thehelpforibs.com site has a lot of information and message boards (fair warning--they also sell supplements and books about IBS). There’s even a site directed at women with IBS.

In the end, you’ll need to have a conversation with your primary care doctor if you’re not sure you’ve got IBS and to make sure it’s not something more serious.

And if you have any unexpected emergencies remember we're always here to help! 

Photo credit: Dranik / Foter.com / CC BY-NC-SA and http://help-health.com/stomach-pain-after-eating/

Tsunamis?! But we live in SA!

This week, Dr. Rat­ner tells us about prepar­ing for the unex­pected. What’s in your emer­gency kit?

Dr. Rat­ner

Most of us here in San Anto­nio do not know that this week is Tsunami Pre­pared­ness week. Just because San Anto­nio is only a lit­tle more likely than Salt Lake City to suf­fer the direct effects of a tsunami there are lots of lessons we can learn from this week.

1. Really bad things hap­pen, even if they’re not very likely to hap­pen. So, do you need life vests? Prob­a­bly not, but you should think of some basic items and pro­ce­dures for any unplanned cat­a­stro­phe. Events that hap­pen far away can have rip­ple effects. Are you pre­pared if your plant closes down because you can’t get parts or your cus­tomers are unavailable?
2. We may not be at risk for a tsunami, but what about a flash flood?
3. How hard would it be to store 5 gal­lons of water and a few days of canned or dehy­drated foods, or some mac­a­roni and cheese for each mem­ber of your house­hold? You could fit a few days’ worth under each person’s bed.
4. Can you put together a small plas­tic type tool­box with a few screw­drivers, a pair of pli­ers, some duct tape, a util­ity knife, some zip ties, a hack­saw and a flashlight?
5. Take a few min­utes and dis­cuss with your fam­ily and your extended fam­ily where and when you will meet in the event of fire, black­outs or other disasters.
6. Once a month buy a few extra AA, AAA,C, D and 9 volt bat­ter­ies, and switch out your used bat­ter­ies with your cur­rent stock. This will prove very use­ful if there’s a power outage.

This is not an all-encompassing list, but it is easy, inex­pen­sive and really use­ful when the expected happens.

It’s not some­thing we want to think about every day, but if we’re pre­pared it can turn a dis­as­trous sit­u­a­tion into some­thing that’s just dif­fi­cult. The Amer­i­can Red Cross has some great resources and advice for all kinds of sit­u­a­tions here. And a tool to help you esti­mate how much you’ll need of every­thing here based on your house­hold. Always remem­ber we’re here to help at IUC, but we hope you have a happy and safe weekend!

The unex­pected strikes…unexpectedly.

Photo credit: United Nations Devel­op­ment Pro­gramme / Foter.com / CC BY

ALERT! Day 2013--Learning more to stop Diabetes

Today is the American Diabetes Association's ALERT! Day. 

Today through April 9, 2013, there's a free online test you can take to help you figure out your risk factors, and for every test that's taken there will be $5 donated to help fight diabetes by a large food company. My risk factor comes up as 4--who can beat me?

Diabetes effects a staggering 14% of San Antonians, which is double the national average (!), causing numerous health problems and putting its victims at risk of amputation, blindness and even death. And the most tragic thing about type II diabetes is that it's almost completely preventable. We all know that we need to eat right, exercise, etc....consult with your doctor to help address any of your risk factors and see how you can help prevent Pre-Diabetes and Type II Diabetes.

To quote from our local ADA office: "The American Diabetes Association's San Antonio office is so committed to finding a cure, educating the public about how to Stop Diabetes and providing support for those living with the disease are central to our mission. We are here to help.

To receive local information or learn more about events occurring in and around San Antonio sign up for our free newsletter! Contact Jose Macias, Online Communication Manager, at jmacias@diabetes.org to sign up!"

There are also a lot of local opportunities to volunteer and help fight Diabetes!

There's even a free Expo coming to San Antonio in May. They're advertising nutrition info, cooking demonstrations and health screenings. What would you like to see at the expo?

Do your ears continue to grow as you age?

Prince Charles may worry about this very question.

There are definitely some changes in the face that occur with aging.  First some facial muscle tone is lost, causing that saggy look.  Then you get the dreaded double chin.  The nose can also lengthen a bit, and the skin on the face becomes thin, dry, and wrinkled.  Then there are longer, thicker eyebrows and gray hair.  We haven’t even mentioned droopy eyes, receding gums, missing, teeth, and last but not least - bigger ears.  Yes, your ears do continue to grow as you age, but only slightly.  This is probably due to cartilage growth.

What a list of wonderful things to look forward to as we enter our golden years.

Excerpt from Why Do Men Have Nipples? by Mark Leyner and Billy Goldberg, M.D.

Seven tips to beat spring allergies

Spring has sprung! And with it comes allergies galore. How do you know it’s allergies and not a cold? The most noticeable difference is that, while a cold will commonly last less than two weeks, allergies will drag on as long as you’re exposed to whatever it is you’re allergic to.

Here are some tips and tricks to make your allergy season a little more bearable. And if you’re still not feeling well, you can always come see us at IUC.

1. To avoid allergens, simply keep your windows closed while you’re inside.
2. Take a shower when you come in from the great outdoors to wash off any potential pollen that’s made you its home.
3. Wash your clothes and bedding as often as possible. Allergens tend to stick to fabrics, and you can easily track them inside.
4. Drive with the windows up to avoid pollen-laden air.
5. If your pet spends time outside, keep it out of your bedroom to avoid any pollen it may bring in on its fur.
6. Pollen is at its peak in the morning, between 5AM and 10AM, so avoid the outdoors during those hours.
7. Treat any potential symptoms before you go outside. Speak with your doctor to determine which over-the-counter or even prescription medications could help you.

Do you have any tips of your own to share? We’d love to hear from you!

Photo credits: OakleyOriginals / Foter.com / CC BY; James Gathany / Foter.com / Public Domain Mark 1.0