T+7 Weeks (w/ Voice Sample)

It has now been 7 weeks since my SLAD-R surgery at UCLA. 

I finally returned home to Hawaii on 5/15. I took roughly 1 month to recuperate in San Francisco with friends. It feels great to be back at home. 

My voice seems to be gaining some volume in the lower registers. It's definitely stronger in the morning and usually reverts back to a whisper towards the evening. It's still very difficult to speak at restaurants and there's no way I can use a drive-thru yet for my morning coffee. However it's very easy to have regular conversations indoors. I am so thankful there are no spasms. My voice right now feels and sounds like I received a very strong botox shot. 

I continue to apply mederma to my scar 3x a day + mederma PM at night. I don't notice any considerable difference in the lightening of the scar. I hope it gets better over time. All of my friends noted the scar is barely noticeable. 

My energy level is back to where it was pre-surgery. I finally returned back to the gym last week. I made it 4x and it feels great despite losing a lot of strength after being away for more than a month. 

The numbness under my chin is slowly going away. The left side feels a little more numb than the right but there's no pain at all. It still feels a little weird to shave with the area slightly numb. 

I'm pretty happy with the progress and hope I have a much louder and functional voice at the 3-month mark. 

T+3 Weeks (w/ Voice Sample)

It's been a little over three weeks since my SLAD-R surgery at UCLA with Dr. Berke. 

My voice is still a whisper and it can be very frustrating at times. The most noticeable improvement is my ability to speak more words in a sentence before having to take another breath. Don't get me wrong, I still feel winded if I'm trying to push the words out in a loud environment. But in quiet indoor environments I am noticing I'm able to hold a pretty normal conversation without feeling light headed. 

This week I finally started exercising again. On 5/2 (Monday), I went for a 2.25 mile jog. I was pretty winded after the first mile so I decided to half walk and half jog for the remainder of it. I also did the same on 5/4 (Wednesday) and today 5/5 (Thursday). 

Prior to surgery I would workout 4-5x a week so it felt good to start exercising again but I can't wait to get back in the gym and lifting again. I need to wait about 1 month post op per Dr. Holliday before lifting heavy weights. 

I still need to be mindful that I don't gulp down liquids too quickly. Other than that, I have been eating and drinking as normal. 

I am able to touch the incision site with no problems. I apply mederma 3x a day in addition to mederma PM before I go to bed. My bottom neck line present before surgery is still more prominent than normal which I'm presuming is from slight post surgical swelling which I can feel when I touch the incision site. It's not painful but just slightly tender and numb to the touch. The scar is a little dark and I'm hoping it will lighten over time. I posted a closeup and regular shot of the incision site below. 

I'm still recuperating in San Francisco and return back to Hawaii on 5/15. 

Incision site

Incision site (close up)

T+13 Days

After landing in San Francisco, everything was pretty normal. I was going out, walking around, eating/drinking as usual until the evening of Tuesday 4/19/16. 

My friends took me to a Poke Bowl shop where I ordered Spicy Tuna as my protein and later realized there was Octopus mixed in by accident. As I was eating my Poke bowl, there were several pieces of white meat and I didn't think anything of it ---- until I saw suction cups! I then realized I ate something I shouldn't have. I've never eaten Octopus before because I know I'm allergic to shellfish and squid, hence I had no idea what those few white pieces of meat were at first. 

Note on my shellfish allergy: If I accidentally eat shrimp mixed in with food I typically get itching and I sometimes have difficulty swallowing. I have never gone into anaphylactic shock or needed to visit the ER due to my shellfish allergy. I have never officially been diagnosed with a shellfish allergy by a Doctor. 

I began to feel itching on my arms and went to sleep. I woke up feeling very tight around my neck and upon further inspection my neck was quite swollen. I took some Benadryl in the morning and again in the afternoon. There was minimal relief so I felt it was best to visit the ER. I was admitted into the hospital on the afternoon of Wednesday 4/20/16. 

Admitted to Mills-Peninsula on 4/20/16

My neck was noticeably swollen on 4/20/16

There was a lot which transpired because the Doctor's at Mills-Peninsula have never heard of SLAD-R surgery and were being extra cautious. They didn't know if my swelling was truly an allergic reaction or a complication after surgery. They even contemplated air lifting me back to UCLA which in my opinion was overkill. However in retrospect I appreciate the Doctors at Mills-Peninsula aired on the side of caution. 

I was on IV from 4/20 thru 4/23. I was allowed to have a liquid diet on the morning of 4/23 and slowly progressed to a regular diet in the evening and eventually discharged on 4/24. 

Discharged from the hospital! 

**Note I've added more details at the bottom of this posting (for those who are interested) in regards to the events which happened at the hospital. The above is a brief summary but overall it was a VERY frustrating experience! But again, the doctors did the best they could with what the knew and I'm thankful for that.**

I got back to the house on the evening of 4/24 and took a nice long hot shower. The steri strips which were already beginning to curl, easily peeled off after my shower. I noticed a big bump on my neck and was a little worried --- but as time progressed it started to go away. My neck was probably squeezed tight from the steri strips and needed time to "relax." 

This morning on 4/25, the bump around the incision spot is barely noticeable and looks pretty normal. The incision site looks very good. If you notice in the photos I have two lines on my neck. The green arrow shows a neck line which was present BEFORE surgery. The red line shows the incision site. The green line is more prominent because there is still some post surgery swelling (or post allergic reaction swelling haha). But other than that I'm happy with how my neck looks. I bought some mederma + mederma PM to begin using within a few days. 

Red arrow = Incision from surgery
Green arrow = Neck line I already had before surgery 

My voice is the same and still a whisper. It's stronger in the morning and weakens as the day progresses. If I talk a lot I do get light headed. 

My diet is normal except I will stay away from ALL seafood whether cooked or raw as a precaution!!!

**Additional events from my frustrating hospital ordeal**

• Wednesday 4/20/16
• Admitted into the ER at Mills Peninsula Hospital 
• They ran an MRI and noticed a small amount of fluid near the right side of the incision.
• I was given Benadryl and an anti-inflammatory steroid via IV.
• Mills Peninsula was able to get ahold of the resident doctor on-call at UCLA; The resident doctor recommended I be on antibiotics and stay in the hospital overnight. They will attempt to get a hold of Dr. Berke tomorrow.
• I am transferred to the ICU step-down floor so I have heart monitors and an IV hooked up to me.
• Thursday 4/21/16
• My neck was still swollen but not as bad as the prior day and the tenderness around the glands has gone down. 
• 9am: The Dr. at Mills Peninsula feels it's a bad reaction to the Octopus. 
• 11am: The ENT at Mills Peninsula examined me and feels it's a bad reaction to the Octopus and is fine releasing me. 
• 2pm: Now the Dr. at Mills Peninsula notified me they will keep me for 5 days. I will be on an IV only diet --- so no food or drink. They contemplated air lifting me back to UCLA but decided to leave me at Mills Peninsula based on information provided by Dr. Berke. 
• 3pm: To get further clarification, my mother called UCLA and spoke to Dr. Berke. He said there "could be" a salivary leakage point causing an accumulation of liquid which "could be" causing an infection. Dr. Berke is concerned that if I continue to eat and drink food, particles could get stuck in the leakage point and want me to be on IV for 5 days for the "possible" leakage point to heal. This is from the SURGICAL point of view. UCLA is making the assumption above based on my symptoms from a post surgery point of view and not factoring in the Octopus. 
• 5pm: A case manager came to my room and informed me they are attempting to transfer me to UCSF or Stanford so I can be provided with a "higher level of care." It turns out the team at Mills Peninsula is not comfortable treating or diagnosing me as they are not familiar with SLAD-R 
• 6pm: Frustration sets in. I am not sure why they want to transfer me to a different hospital because: 
• #1: I have never had a fever even prior to being admitted into the hospital 
• #2: My blood pressure has consistently been below 120/80
• #3: There were no visible signs of infection (leakage etc..) other than the swelling which did go down with the Bendaryl 
• #4: No swallowing issues 
• Physically I feel perfectly fine. 
• Friday 4/22/16
• 9am: 
• The Dr. came to examine me and now is concerned because my neck was slightly red. I explained my skin is very sensitive and she just examined my neck which turned red after.
• The Dr. is now concerned about Celulitis and wants to drain the fluid around the incision site 
• 10am: 
• UCSF does not want to touch my incision because "it's so minimal" and it's normal post surgery fluid -- The Mills Peninsula Dr. said UCSF would have just discharged me but they will not follow that recommendation. 
• Stanford said they have 60 people lined up in the ER and are unable to take me 
• So the Dr. at Mills Peninsula will ask the radiology department to drain the fluid 
• 11am: 
• Medications being taken: 
• Prednisone
• Protonics 
• Ampicillin 
• Vancomycin 
• 1pm: 
• The ENT came to visit me and said they will attempt to extract the tiny pocket of fluid 
• Best case scenario - It's just dried blood and post surgery fluid. 
• Worse case scenario - It's pus and will better determine what antibiotics to use 
• However the ENT thinks it's just dried blood and I had an allergic reaction to the Octopus 
• 2pm: 
• Now the draining of the incision is cancelled. The radiologists aren't comfortable removing the fluid because it's a little deep
• They will continue to observe me in the hospital 
• Saturday 4/23/16
• 8am: ENT came to visit and said I look really good and wants me to start eating a liquid diet and evaluate if it causes anymore swelling. If there's no swelling, I will be discharged by Sunday at the latest. They just want to make sure there's no salivary leak/incision. 
• 11am: Doctor wants to observe me overnight again and discharge me tomorrow 
• 5pm: I'm given the green light for solid foods! YAY! 
• 8pm: I'm moved from the ICU step-down floor to a regular room. The heart monitors are finally taken off and the IV is only reattached when I need my medication! 
• Sunday 4/24/16
• 9am: I am notified I need a few more dosages of vancomycin and I will be released about 7pm tonight
• 7pm: #freedom 

T+7 Days (w/ Voice Sample)

Over the weekend I started to develop a hacking cough. It starts off as a tickle in my throat and I begin to cough profusely. Sometimes there is clear phlegm which comes up and other times it's only a dry cough. It's made it a little difficult to sleep but I find sleeping on my side helps a lot. After a few minutes it goes away. 

The area under my chin/neck feels very numb to the touch. I did bring this up to Dr. Feinstein on Friday and he said others have reported the same issue after surgery. (The area above the incision leading up to my chin)

On Sunday 4/17/16 - I hopped on a plane from LAX-->SFO. My mom helped me communicate if needed. She will be returning home to Hawaii and I will be recuperating in San Francisco with friends until 5/15/16. 

Goodbye LA!

I originally planned it this way thinking I wouldn't be able to eat solid foods for 25 days, have a persistent cough with swelling and pain in my neck. The only issue I have is the intermittent cough and numbing of the chin. Technically I could fly back home to Hawaii but since everything is already arranged I will just enjoy the time with friends here in San Francisco.  

I was out from 8am when we left the hotel for the airport and I didn't get "home" until 6pm in San Francisco as I had lunch and went out to the city with friends after landing. This was the longest I've been out and about and I was completely exhausted. I ended up sleeping for 12 hours. 

The steri strips are starting to curl slightly but there's a lot more to to go before it falls off on its own. It has only been one week so I refrain from touching it. When I go outside I do wear a scarf to protect it from the sun --- I know I still have the steri strips on but I don't want to take any chances of the scar darkening. 

In regards to my diet, everything is back to normal food-wise. As for liquids I can drink anything except 1) I need a straw and 2) I can't take huge gulps. 

I don't know if this does anything but several times a day I try to do mouth movements to move the area under my chin to alleviate the numbness. I also massage under my chin with my fingertips. For the neck area, I attempt to SLOWLY look up, left, right and down repeatedly for several minutes so my neck does not develop any muscle tension. There is no pain -- only some pinching from the steri strips.

As for my voice -- It's VERY breathy. There is no way I can be heard at restaurants. I am able to be heard indoors over the dining room table with a lot of effort. My friends can hear me while we are driving as long as the music is turned down and I'm leaning forward slightly (they're in the front and I'm in the backseat). But there are no spasms! 

T+3 Days

This morning I woke up and the incision is a bit tender. It looks slightly swollen but there's no pain. I took my steroid medication and antibiotics at 6am and fell back asleep until 9am. 

It was a nice day so we went for a walk through the botanical garden right across the street. We saw some butterflies and squirrels running around. It was quite nice as it's Sunny and about 65 degrees outside. 

Selfie at the Botanical Garden! It feels so good to be outside!

Seating area at the Mildred E. Mathias Botanical Garden

It helped me to work up an appetite and we walked to Denny's to order some takeout. Today I was able to eat: 

• Scrambled Eggs 
• Hashbrowns 
• 2 Sausage Links 
• Smoothie 

The amazing thing is I haven't needed thick-it other than on day 1 after surgery. I am swallowing just fine and pretty happy with my progress! 

I am a little worried about the tenderness in my neck. Below are two photos. One at 6am and another at 2pm. I've been on my antibiotics for a little under 24 hours. I'm not sure if there's slight discharge but it could be residue from a few days ago. I left a message with Dr. Berke's office and haven't heard back yet. I will continue to monitor the incision for any changes. 

Neck at 6am

Neck at 2pm. Slightly less swollen

Update @ 5pm: 

• I saw Dr. Feinstein (Resident Physician) and he said the incision looked perfectly fine
• It was comforting to hear especially before the weekend and knowing I will fly from LAX-->SFO on Monday 
• The swelling is going down from this morning so it looks like the antibiotics are working as they should 

I was craving some Starbucks and I was actually able to drink an Iced Venti Soy White Mocha without Whipped Cream in addition to a Chocolate Croissant. 

Tasted so good! 

I got back to the room and rested. I'm quite exhausted even though I haven't been doing much. I know the trauma from surgery probably tired my body out. 

T+2 Days

I woke up at 6am, took my medications and fell back asleep. I got back up around 10am feeling very well rested. 

My mom went down to Denny's and bought me a bowl of baked potato soup, mashed potatoes and a strawberry banana smoothie. It tasted so good I devoured all of it! 

Post Op Appointment: I felt this was the most uncomfortable part of the process so far! My large bandage was finally taken off which allowed Dr. Berke to apply some pressure to the incision. This was VERY uncomfortable and the first time I felt real pain. He wanted to ensure there was no liquid building up underneath the incision. 

Another ENT on his team attempted to take video of my vocal chords. This was VERY uncomfortable. They eventually had to use the laryngoscopy through my nose and down my throat. This was a lot more comfortable than the camera going straight down my throat from the mouth. 

Dr. Berke noted my incision looked a bit swollen. He also asked if I was prescribed any antibiotics which I was not so he prescribed something to help with the exterior swelling. We picked this up at CVS and headed back to the hotel room. It felt really good to walk around outside! 

I was feeling pretty good about my swallowing abilities so I had the following for dinner from Denny's:

• Grilled zucchini and veggies 
• Scrambled Egg 
• Potato Soup 
• Strawberry Banana Smoothie 

All of it went down smoothly and I also took my steroid medication without having to crush the pill! 

T+1 Day w/ Voice Sample (Day after Surgery + Discharge Day!)

I woke up at 5am feeling some pain in my chest area and when I swallow. It was very minimal but I requested some pain meds at 5:30am. The pain felt like it was from the breathing tube from during surgery. 

Around 730am a lot of Dr. Berke's team came to visit me. They removed the bandage and inspected the drain tube. They said it looked very good and it was dry so they removed the tube, added steri strips and placed the large bandage back on my neck. 

Dr. Holliday came by about 8am with some pudding. He taught me some techniques to swallow. I started off slowly but eventually got the hang of it. He said I am now allowed to eat puree'd food. 

My first meal was puree'd pears, soy milk, and pudding. 

My first meal in over 36 hours! 

I downed the pears and pudding! I added a packet of thick-it to a small amount of soy milk. 

Around 10am Dr. Berke's team came to visit again and checked on how I handled breakfast. Because I did so well, they asked if I wanted to be discharged today! Of course I said yes! 

I walked around the recovery unit to get the blood flowing in my legs. I also met and spoke to a friend I made on the SLAD-R Facebook page! It was so nice to have support in the same recovery area knowing we both were going through the same thing. 

I then ordered lunch which consisted of puree'd chicken, mashed potatoes and a bowl of potato soup.

Second meal the day after surgery

The lunch disappeared quite quickly! The RN then came by with my discharge papers to sign. Dr. Holliday also made a last round to ensure everything was ok. The pharmacist came by and dropped off several medications: 

• Steroid for the internal swelling
• Antacid 
• Pain medication (liquid form) 
• Stool softener (to use with the pain medication) 

Around 4:30pm, I was wheel chaired to the shuttle pick up area and taken back to the hotel. 

Time to be discharged!

Because I was discharged a day early, I still wasn't able to remove the large bandage or shower. I managed to rinse/wash at least my hair. 

Before bed I inhaled a container of applesauce. I then took some pain medication even though I probably didn't need it. I wanted to ensure I slept comfortably. 

Below is a recording made in the morning: