More surgery to come.

Dr. Cossette wanted to give Al's vocal cords some time before proceeding with anything further. When we saw him in January, he scoped Al again and was disappointed to see how little airway is available. After his laser surgery last summer when they removed scar tissue from his vocal cords, Al had a better airway. Unfortunately, the airway is still restricted (about 5-6 mm compared to a regular person's 12-15mm) and the scar tissue will grow back. When he gets a cold or any kind of infection, that airway is even less.

So we've been referred to Dr. Garnett, an otolaryngologist at KU Medical Center in Kansas City, who scared the life out of us. (The other patients in his waiting room gave us a bit of a start, as well.) He looked at the photos from last summer's surgery and the scope done at Dr. Cossette's office recently, and gave us all the skinny on a trachestomy. Short of that hand-held machine that you use to speak when your vocal cords don't work, a trach has been Al's biggest fear, though we now understand it's not if he has one, but when. Dr. Garnett explained that this part of your body responds to radiation by creating scar tissue for the rest of your life. Also, the radiation killed off the saliva glands in that area, so that is why Al's always fighting mucous build-up -- the saliva would be thinning out that mucous so it's more easily expelled -- resulting in that hideous cough he's lived with the past five years.

He went on to tell us all about a trach (see Hood Stoma Stent if you really want to know) and how much better the stents are now and how much better off Al would be with a trach. (Prior doctors have advised us to put off a trach until there are no other options due to potential complications and just the ick of dealing with it!) So we were figuring that would be his solution until Dr. Garnett scoped him in the office.

Evidently seeing for himself changed his mind, and he recommended a cordotomy. The long and short of this procedure is to remove a section of the right side of Al's vocal cord (which is immobile and unresponsive, due to the radiation) to increase his airway. The left side of the vocal cord will overcompensate to allow him to talk and it should allow him to move more air. They leave a stitch in his neck holding the vocal cord open, which allows the incision to scar over when it heals and hold the vocal cord (and airway) open. He explained that Al's voice would be raspy for a few days, but should be vastly improved in pretty short order.

So they've scheduled the surgery for April 29 (which is FAR too long in Al's estimation, but we didn't get any choice!) at KU Med in KC. He'll be in the hospital overnight, and he's decided to take a full week off to heal. Then we'll go back on May 18 for a check-up, and at some point another surgery to remove the stitch.

We're both happy to have something hopeful on the horizon, but it can't come soon enough; this man needs to breathe, after all! Thank heaven for optimism!