This will explain how my stroke effected my speech and how I regained it. Unfortunately getting a loud voice was VERY difficult to get consistently. I could get voice sometimes but it was very tiring. I usually wouldn't even try unless I had to. I started going to another Speech Therapist (summer of 1996) because I went for an inpatient hospital stay. My new therapist suggested an ENT evaluation. I went to a doctor for a video stroboscope (this is when they make a video of your vocal cord movement). Well, my vocal cords were not paralyzed but they weren't closing completely. There was a gap in the middle and that is why they weren't closing completely. That accounted for the lack of vocal cord vibration and a whisper like voice. I was referred to the doctor's associate. He looked at the video and saw that I was a candidate for bilateral implants, vocal Medialization. He explained that this operation is more frequently performed when one vocal cord is paralyzed but he had seen it done on both. He would have to make an incision on my neck and cut away the cartilage by my vocal cords and then fit implants onto each vocal cord. This would push the gap close enough together that they would vibrate when I talked but not too close that they would inhibit breathing. He asked me if I wanted to try the operation. I whispered yes.
           It is Wednesday, October 9,1996, I had my operation yesterday, vocal Medialization. By writing this right away I am hoping to capture all that has gone on in the last 24 hours or so.
           We, my wife and I, started getting ready about 7:30 yesterday morning. If all went well we should arrive at Greater Baltimore Medical Center (GBMC) by our 11:00 check in time. We were lucky and got there at exactly 11:00. It would be "hurry up and wait" the rest of the day. They checked us in at 11:15, not too bad of a wait. Then we went to our next staging area for 15 minutes, not too bad either. We were told to proceed to Stage 3. Now the real waiting began. First we were visited by my anesthesiologist after about 15 minutes then about 15 minutes later a nurse and my wife put me on the gurney and got me dressed. So far everything was happening at about 15 minute intervals but at Stage 3, after the nurse, the wait began. I was originally scheduled for 1:00 surgery. For some reason it was changed until 2:00.
           Now, throughout the day I want you to realize that I haven't been allowed to eat or drink anything so I'm getting hungrier and hungrier the whole time. We were lucky to get a few visitors so this helped pass the time. My pastor came to pray with us (I was really glad he did this because I figured I'd need all the prayers I could get) and my wife's uncle came (he has been one of my best supporters since my stroke and often performs physical therapy with me on the weekends). Anyhow, that passed about another hour so there was only about another hour wait. Two o'clock came and I was ready to go.
           Fortunately so were they. By 2:15 I was all prepared for the operation. IV's, local and general anesthetic, heart monitor and a few other things. They put a towel over my eyes but between my imagination and feeing the pressure of their hands and noise from instruments I'll try to recount the procedure. The incision isn't ear to ear but it's about 4" long. It took at least an hour or more for preparation of implants. Folding back my skin, moving fat and muscles, grinding away the cartilage by the vocal cords on both sides for the placement of the implants. They took lots of measurements because the implants are held in by pressure from the area ground away. They are snapped in. When the areas were prepared it only took a few moments to put them in. The doctor went down my nose to my throat with one of those long fiber optics and checked by having me make sounds. Then the procedure was over. They took another hour to close. The junior doctor and intern did this. My doctors job was done. I think there are two layers of internal stitches and one that looks like a zipper on the outside.
           Next it was on to the Recovery Area. I was there until about 6 o'clock. I then went to my Private Room (my wife was spending the night to help with my special care and communication needs-I had made this a mandatory requirement with her before). The nurses there had to take the same vital signs that they had just taken in Recovery (if you have spent much time in a hospital, like me, you know the routine and what a bore-but important). I ordered dinner at about 7:00 and got it at about 8:30. I was soooo hungry.
           What was neat was that I COULD TALK! I mean I could talk before but it was primarily just a whisper. This was with a voice. I had to tense up and push initially (I call it "kick starting" my voice) but after that it came easily. I'm not sure though how it will be permanently. My doctor said that when he looked inside there was some very minor swelling of the vocal cords. This means that some (I don't know how much yet) voicing may be attributed to that. My voice is pretty good though...at least to me and my family.
           It's not perfectly normal. I'm still dealing with dysarthia. Poor breath support (I can only say about two words clearly/breath, 4-5 and I lose clarity of some words) and weak lips and tongue. Words with blended consonants, i.e. fl, pl, str, and sq are a few of the blends that are difficult for me when used in words. Also, because I wear a palatal lift which blocks most of the air from escaping out my nose, n's and m's are VERY difficult to pronounce. You would still probably have difficulty understanding EVERYTHING I said. But I'm grateful for this great improvement. I'll be able to focus on more things in speech therapy like breath support, articulation and some other things that I couldn't before. One of the effects from my stroke is, although I have continually showed improvements over the past two years, I would equate that improvement to a "normal" stroke survivor's improvements over two months or less. Needless to say, I'm expecting a long road to recovery.

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