When an SLP Loses Her Voice Thyroid surgery and its complications put a clinician in her patients’ shoes. First Person/Last Page
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First Person/Last Page  |   October 01, 2017
When an SLP Loses Her Voice
Author Notes
  • Erie Louison, MA, CCC-SLP, is a contract clinician in Homestead, Florida. erie.ade@gmail.com
    Erie Louison, MA, CCC-SLP, is a contract clinician in Homestead, Florida. erie.ade@gmail.com×
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Speech, Voice & Prosody / First Person/Last Page
First Person/Last Page   |   October 01, 2017
When an SLP Loses Her Voice
The ASHA Leader, October 2017, Vol. 22, 72. doi:10.1044/leader.FPLP.22102017.72
The ASHA Leader, October 2017, Vol. 22, 72. doi:10.1044/leader.FPLP.22102017.72
July 22, 2016 changed my life. I had been a speech-language pathologist for 16 years, treating children and adults in private practices, schools and nursing homes. After working as a traveling therapist, I settled in sunny south Florida, working at a private pediatric clinic. In early July 2016, I made a middle-of-the-night trip to the emergency room with severe chest pain. I don’t have heart problems—I thought it might be indigestion.
I was shocked by the diagnosis: a multinodular substernal goiter. My thyroid gland had tripled in size and grown into my chest cavity. The goiter also was compressing my trachea. Doctors asked if I had trouble speaking, swallowing or breathing. I had been wheezing for the past few months, but attributed that to seasonal allergies.
A total thyroidectomy was recommended. If not, the goiter would continue to grow and completely close off my airway. The surgeons would try to remove it through my neck, rather than through my chest. They mentioned possible side effects, including damage to my vocal folds or laryngeal nerve. “Do what you have to do,” I replied.
The July 22 surgery was just weeks before my 41st birthday. The surgeon didn’t need to make a chest incision. But post-surgery, something didn’t feel right: Talking was difficult and I coughed while eating and drinking. I immediately put myself on vocal rest and on a mechanical soft diet and thickened liquids. I made sure my head stayed elevated while in bed.
I was discharged from the hospital after two days. My swallowing improved, but I could hardly speak above a whisper. I used a microphone to communicate at home. I could not be heard in noisy environments. I avoided talking on the phone. I spoke in short phrases because longer sentences required breath support I didn’t have. I fatigued easily and conversation was a chore. I couldn’t sing. I couldn’t work.
An ENT diagnosed right vocal fold paralysis and recommended vocal fold augmentation. He injected the paralyzed fold with a gel to “bulk it up” to improve its contact with the functioning fold. It was a temporary solution—we hoped that during the few months it lasted, my laryngeal nerve would heal and the vocal cord would move again.
Two weeks post-augmentation, my volume improved. People could hear me. My voice quality changed, sometimes sounding raspy, and my pitch was lower. Vocal fatigue still plagued me, so I limited talking and avoided strain. I couldn’t work, because I didn’t know if my voice could handle the demands. Frustrated and nervous, I considered going into another field. How could I provide therapy if my voice was impaired? What type of work could I do? Would my 16 years of experience go down the drain?
In December 2016, I was diagnosed with reflux, which was hindering my voice recovery. Medication management helped. By mid-January 2017, my voice became stronger and sounded better. In February, I returned to work part-time, and by April, I was back for good.
My voice is now about 85 percent of what it used to be. I sometimes get hoarse at the end of the day and I have to remind myself to use good vocal hygiene. My singing range is lower, but I can still sing “The Wheels on the Bus” in tune. I can’t project my voice the way I used to, but that’s OK—that’s what microphones are for. I have a prominent neck scar that I used to cover with a scarf. Now it’s a conversation-starter.
My swallowing and voice problems have given me a new perspective. I understand the fear, anxiety and uncertainty of medical outcomes. I know the frustration of being unable to communicate normally. I understand wanting to eat regular food instead of a modified diet. I relate to the possibility of unexpectedly starting over in a new career.
This experience has given me drive to develop new professional goals—pursuing a doctoral degree, writing and teaching. The ASHA Community and other social media groups have allowed me to connect with SLPs who have provided support and guidance—and for that, I am grateful.
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FROM THIS ISSUE
October 2017
Volume 22, Issue 10