A Mini-Post Update (a residual complication; second surgery)

Post Second Surgery Throat Exercises (issues with positioning and post-intubation)

1. Loss of vocal timbre (less robust sounding voice) exercises:
   • Warbles:
     • Aha-aha ~ aha-aha (different pitch levels)
   • Glides (base to treble, treble to bass - as much of the vocal range - as possible):
     • Ah —— ah! Ah…aah!
2. Inability to swallow:
   • Pharyngeal contraction (strengthen ability to swallow):
     • Mendelsohn Maneuver
     • Take breath through nose, hold it, start to swallow; freeze it at the top; silent count to five and then complete the swallow
   • Rapid, successive, swallowing (strength, timing, with emphasis of coordination of aspects of swallowing):
     • The goal is to take small sips of water, swallow; immediately following, chain them together in rapid succession

Brief background:

Going into my second surgery -- unlike all other times before -- I was not transferred to the operating table before anesthesia induction and intubation. Rather, they kept me in my original hospital bed while the anesthesiologist began pre-oxygenating me (as indicated by the nurse holding the bulky anesthesia face mask on my face), placement of a secondary IV in my right hand, along with him pushing bolus after bolus of various anesthesia meds into my IV line, one-by-one until I was dizzy and finally find myself unable to keep my eyes open.

Unexpected issues/complications upon awakening (general anesthesia induction/intubation on secondary bed/not OR bed = prone position!)

What I wasn’t aware was once I was asleep, they moved me into the prone position, IV/breathing/foley tubes and all. It was in this prone position that I would spend the next five hours, unconscious and unable to respond, let alone reposition into the correct position. Instead, I began observing, one-by-one

I felt (unbeknownst to me at the time, a pressure sore on the left portion of my mandible), as well as the entire left forearm and the top of my left hand (but could feel my fingers). Additionally, my right ear was numb/swollen/hot and so was the right side of my: head, shoulder, breast, right upper arm along with 90% of my throat (starting from the right side, both deep and superficial). At first, it felt like breathing was difficult, but fortunately it only felt that way. However, swallowing was a whole ‘nother matter entirely. In addition my vocal timber has been affected. At this point nine days out (at time of this writing, 08-31-2022) from my previous surgery, while many of these “asleep” areas have woken up from this, there was concern that some of this may lead to permanent nerve damage. Currently, the swallowing issues are of primary concern.

At day 13 of my total hospital stay, while I’m not 100% sure what is is keeping me here, I believe it is partially pain management (and my pain needs still requiring routine IV pushes of Dilaudid, a higher dose of meds they are attempting to wean me from), some area of physical therapy signing off, a factor of case management arranging equipment rental (such as a wheel chair), and case management also deciding if being released into acute inpatient rehab is a consideration from an insurance standpoint.

Personally, I am perfectly fine with remaining in the hospital for another week if my pain is appropriately managed (an area of my care that deserves an entirely different synopsis post, a weak point in what has otherwise been nearly flawless care here at UCHealth), and if, presuming, what I’m learning from an occupation health (OT) side of things focuses on independence at home, and physical therapy (PT) side of things offers me exercises that are appropriate and inline with my currently level of healing (for instance I still the staples and sutures in my leg, my residual limb remains swollen, and I’m still required to wear a shrinker; on that topic, a shrinker is a very strange medical device to wear, consisting of an elastic fabric that is sown together to form a cone shape with another piece of fabric that follows up your hip into a waist band to “prevent it” from working it’s way down).