Janice Williams Loves Austin And sometimes I write about it.

April 19, 2008

Botox Day

Filed under: Food,Spasmodic Dysphonia — Janice @ 1:15 am

People give me a funny look when I tell them I am going to get Botox. The assumption is, almost universally, that I am going to get Botox for wrinkles in my face. Even people that know me and know that I have voice problems and know the Botox is the accepted medical practice have WRINKLES pop into their head before anything else. But it was for the voice and I made the trip to see Dr. Simpson today. And, no, there was none left over that he could pop into my forehead or crow’s feet (people always ask that, too.).
Again, I’ll tell the whole story one of these days in the blog, but I have spasmodic dysphonia, but I have had a reasonably good voice for the last couple of years. It is an effort to talk, however, and I am trying Botox again to see how much ease it might give me. I have given people the analogy (I love analogies) of walking through a swimming pool. One person has to walk the length of a swimming pool  . . . wait, let’s make it the width, we wouldn’t want them to drown in the deep end . . . the width of a swimming pool. Another person is going to race them alongside the pool, out of the water. Who wins? Sure, you CAN walk in water, but it is a struggle and takes effort and it isn’t the easiest or fastest or most comfortable way to get somewhere. That is how my spasmodic dysphonia feels. Lots of effort.

Dr. Blake Simpson is my otolaryngologist and he teaches at the UT Med School in San Antonio. I never quite understood what the deal was today, but it was a trade show and educational seminar for ENTs. They had meetings and seminars, but my part was in a small conference room at the Gunter Hotel where they had tables set up with the latest and greatest advances for ENTs. Dr. Simpson was demonstrating his techniques of administering Botox for the visiting physicians (some were from Mexico, I don’t know about the others, but it wasn’t just local).

I met a lovely woman from Corpus Christi in the lobby/waiting area, Mrs. Munoz. She has had Botox treatments for just the last four years since she had a growth removed from her larynx. She had gone a year since her last dose and was very soft-spoken and strained. We discussed our luck with Botox and she was surprised that I have my shots administered down the throat. She has hers “stuck” in through the outside of the neck. I was surprised to hear that because Dr. Simpson practically pioneered (or maybe he DID pioneer) down the throat and thinks it is much better. I asked and he said that some people gag so badly that they can’t do it the way I have it.

So they called me in for the demonstration and in this highly sophisticated medical gathering, they had stacked three hotel chairs on each other for me to sit on. Not quite the medical facility I am used to! And where Dr. Simpson usually has a resident working with him to hold and direct the scope, this time he took a volunteer from the audience! Yikes. I THINK the guy was a doctor. Maybe I should have asked for credentials. Dr. Simpson introduced me with the anonymous name “J,” which seemed so silly to me. Is there a reason I need to have my identity hidden? I guess medical people are so used to all the HIPPA rules they are careful.

Maybe when I go into the whole story I’ll go into every detail of the procedure. It isn’t for the faint of heart, that is for sure. But first there is Afrin sprayed up in my nose, then something akin to antifreeze to deaden the nasal passages, then sprays in the throat to deaden the throat. Once they get all that deadened (and so far it is uncomfortable, but not horrible) they run the scope up the nose and down the throat. All the doctors could then see the whole procedure on a bigger screen. Not huge though, they were all crowded up around me (and I thought I’d be up on a dais!). Now he takes a syringe and drips Lidocaine down into my throat onto the vocal cords. Drip drip drip. Yes, this is very uncomfortable and makes you gag and choke and cough. I looked up Lidocaine and it is used for skin rashes and such, but it is a local anesthetic as well. He kept dripping and dripping until he demonstrated to the audience that he could poke around my vocal cords and everything that should make me gag and I didn’t notice. Then he took a long syringe and went down and injected two places on the vocal cords with Botox, the deadly poison. There is all the makings for an “accidental” death plot to a novel, isn’t there? I know in the past he has pulled the syringe out and gone back for the second shot, but today he did it with just one “down the throat.” I asked and he said he has gotten better with practice. I guess that’s great, but I hate to think that we are all being “practiced” on by doctors. But then, they do call it “practicing” medicine, don’t they?

Okay, maybe 15 minutes and I was in and out. I think in his office things are lot more slow and there’s a lot more hand-holding and checking “are you okay?” although I still got an abundance of that today, too, which is absolutely necessary to have when someone is shoving sharp instruments and poison DOWN YOUR THROAT!!

Oh, the funniest part was before he did the procedure, Dr. Simpson said, “Now you say you want a bigger dose this time?” I said, “Yes, I want the biggest dose so I can see how it does” (since previously we have been very conservative, hoping for little or no side effects). He said, “Okay, but you’re going to regret this,” then, to the audience and me, “That’s just what you want to hear from your doctor, isn’t it?” He felt like I would regret it in these first few days of choking. We’ll see.

The choking has not begun yet and that concerns me. Maybe I have forgotten when the choking part starts. On the way home from San Antonio I was having some choking problems so I just quit swallowing! The vocal cords aren’t working well to prevent liquids from coming down the windpipe, so even swallowing your saliva can start choking as your windpipe says, “Wait! What’s this?”  Once I had waited the hour he asked me to wait before eating or drinking, I got a chocolate malt at Whataburger. Thicker liquids are easier to swallow and SO soothing. (Although my rant about the demise of the American malt will be published one of these days.)

I got home and napped a good nap. When I got up I drank a glass of water, well, chugged a glass of water, and then realized that I wasn’t choking. That may start up again once the Botox has actually taken effect. Today’s choking was from the Lidocaine and the next choking will be when those nerves die that were controlling a lot of the vocal cords. We’ll see, I guess.

Interestingly, there is a possibility I don’t have SD at all. Wouldn’t that be interesting? Since I have had such a rebound and good voice for a period of time, though it still takes effort, Dr. Simpson said it possibly could be MTD, muscle tension dysphonia. I’m just beginning to read up on it, but it could be very likely when I think of what all has happened over these four years. Either way, Botox can help it, but if it is MTD there are other treatments to explore.

Thanks for all the well wishes for today. This step went fine and I have voice tonight pretty much like I had last night (possibly a little worse). Tomorrow or the days to come will the interesting ones to see if it gets breathy  or high or whatever. And again, thanks to Veronica Aleman, who works with Dr. Simpson, for getting me into this demonstration and always being so sweet in setting up these appointments (none of this is like a regular doctor where you just simply schedule an appointment). She was kind enough to even escort me to my car and was prepared to pay for my parking. At $16 a pop for the Gunter valet service, I was happy to let her, but the nice people at the Gunter saw that I had only been there an hour and said, no charge. Nice people everywhere you go in San Antonio!


Aside from the Botox, I also had lunch with Scotty, who many of you know. She was the promotions director at the station for several years and I wasn’t the only one that cried the day she left. She was phenomenal. She really put heart and soul and huge effort into a thankless job. I was never so amazed as I was when she took over. She was fresh out of college and never once asked “How do we do this?” or “What should I do?” She just DID. I wish I knew how she became what she is. She had no fear. She set me up with a great outside gig one time and when the people were jerks about paying me, she got on the phone and I had a check by FedEx the next day. She made things happen. It was wonderful to see her and to see her doing so well. She got married to wonderful Clifton and they have a happy life. And we had lunch at Chris Madrid’s, a place that Scotty has raved about to me for years, so I was glad to experience it with her. Man, that tostada burger is GREAT!


  1. After reading all the maybes and likelies and what ifs of the Botox treatment, I’m not sure I am wanting you to have had it. But now that it is a done deal, I’m confident that the pain of talking and your voice will improve tremendously.

    Comment by pat — April 19, 2008 @ 9:39 pm

  2. I enjoyed reading your adventure with Botox! I too get Botox down the throat instead of through the throat. My Doctor says it is easier to pinpoint the right muscle for AB by going down instead of through. Apparently the muscle they shoot up for AB is behind the vocal chords instead of in front of beside? He did say that some people can’t have it while awake because of the gagging thing so he knocks them out (in the hospital) to do it.

    Don’t you love the after taste of all that good stuff they shoot down your throat and up your nose? For me that is the worst part! The last time I had Botox I didn’t experience the choking until about a week later. I don’t know why but the shot seemed to work really well. Maybe it is a good sign?

    Good luck!

    Comment by Trisha — April 20, 2008 @ 12:07 pm

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