It’s Over

It’s been ages since I have written something. Quite frankly, life has held a tight grasp on me, taking away my thoughts and my muse. One could call it writer’s block I guess…

This is the first blog I am writing in a state of health I still can’t quite grasp I have reached.I had another follow up yesterday – one of many in the last year, well ok, the last 13 years to be exact. But this was to be different.

A few weeks ago I was scheduled to have another, thankfully very minor procedure done to improve my voice. It holds the lovely name Ishhiki Thyroplasty. Those that have heard me after the LTR know that I has trying my best to make myself heard, but often with very little success, at least in crowded and noisy environments.

This was one procedure I was actually looking forward to – and NO, not the drugs contrary to popular belief. It was because I was standing a chance of getting a more audible voice, improving my quality of life, getting some of my personal identity back. And yes, being able to shout again…. hopefully.

I went in as usual to participate in running the gauntlet from one doctor to the next and actually saw familiar faces. Although I could barely recognize the anaesthetist involved in my previous two operations as he had grown a full beard. 

And so the waiting began. And I waited and waited and waited….. as usual. This time round it was slightly different as I wasn’t alone – at least not totally. This ISS gang has turned into a very tightly knit community and friendships have emerged from it. The head-administrator had come all the way from Australia to have the reconstruction surgery done and funnily enough she had the procedure the same day as I had mine. But as I was classed as day case and she as in-patient, we were in different parts of the hospital. But, Facebook Messenger is a wonderful thing to say the least. We had kept each other company throughout our waiting time. It is good fun sending pictures of hospital couture and comparing different designes.

My time came earlier as the larger procedures tend to be done at the end of the day. So, said anaesthetist was responsible for sending me off to the land of nod, but not before I had the pleasure to be introduced to a visiting American doctor, who had been working with my consultant at this point. Talk about feeling like an exhibit again. But, I did go through my medical journey and couldn’t help but embarrass my surgeon by saying ‘he is the man‘ (he IS the man!).

Another thing I couldn’t help doing was to make sure the anaesthetist would be using plenty of TLC for my friend later on. I would love to know what he was thinking at that point. Probably something along the lines of ‘aren’t there nicer places to meet than in operating theatres?‘ The going under bit wasn’t all that pleasant for me as they did not use a diffuser this time but injected the happy stuff directly into the IV canula. Sufficed to say, that stuff stings like hell! I mean, come on, this is supposed to be a gentle, pleasurable experience, not a ‘get this bloody needle out of my arm RIGHT NOW!

The next thing I remember is waking up in recovery. It was tough coming out of the land of drugs, more so than usual, but that was nothing that alarmed me. What ended up confusing the hell out of me was ‘oh, you can go home after this‘. Excuse me? I was told I would be staying over night, had made arrangements and now I can go? Don’t get me wrong, I dislike hospitals at the best of times but even then I prefer knowing what is happening (yes, I admit it, I am a control freak of sorts). Now, pair that up with not being allowed to talk at all, it is rather difficult finding things out from other people. I felt like crying. Well, I did actually cry.

I had a lovely recovery nurse who never left my side. She did her utmost to get me onto the ward as soon as possible. As I was being taken to my resting place for the night, I happened to bump into the next Guri Girl as she was being wheeled to the operating theatre. It was a ‘reality TV moment‘ as pointed out by the anaesthetist. I couldn’t speak so I did the next best thing as far as I was concerned – I grasped her hands and squeezed hard in reassurance. And so I went my way and she went her’s.

As far as wards go, this was the nicest I have been on in this hospital. I even had a small room that was occupied by only two other ladies. There was one downside which showed up quickly, but I managed to nip in the bud just as quick. You see, when you are not allowed to use your voice you are in a way, totally helpless. It doesn’t help when people don’t take the time to actually listen to you. Worse, when they make you feel like complete morons. I was trying to order dinner and had asked a few questions regarding what I could order. As usual, it was assumed what I was asking rather than waiting to find out what it was I was actually asking. And to top it off, in the end the lady opposite me then used baby-type gesticulations to try and get me to understand what she was trying to tell me. This was despite me saying several times that I am fully capable of hearing and understanding, that I just wasn’t allowed to talk. In the end I went to the charge nurse and made it clear I wasn’t stupid and didn’t appreciate being treated as such. Thankfully that resolved the issue but it is a shame you have to take a stand and get your point across rather bluntly at times.

The night went by quickly, well, as quickly as it can in a hospital, I was picked up and then the real challenge began – total and utter voice rest for three days. Not easy when you have a six year old to deal with as well. I did end up enjoying my time of vocal rest however as I could easily keep out of most situations.

And then the moment arrived. Day for post-ITP: I was totally scared to actually use my voice. I just did not know what to expect. I remember I kept thinking ‘what if this hasn’t worked, what if my voice is worse than before, what if, what if, what if,……‘. It had taken me a good part of the morning to pluck up the courage to speak for the first time. And you couldn’t really call it speaking, it more resembled a croak or something. But it was audible.

With that would begin the journey of speech therapy, which I am still undertaking regularly, accompanied with daily vocal exercises (and yes, they still make you feel totally silly)

And of course another follow up with my surgeon was scheduled. The main man called me through himself, stuck that hideous scope down my nose and told me something I didn’t think I’d be hearing for a while yet: ‘Come back in 12 months‘. For me these words feel like ‘my dear, it is over.’ It is finally over. And I still can’t grasp it. To know that I won’t be facing surgery after surgery to enable me to breath… there are no words for it. A 13 year long chapter is closed. And it has taken three major surgeries and countless minor ones to reach it. Ok, so my voice is not as it was. There are things I probably won’t be able to do with it. And moments of despair for this will come from time to time (pitty-party = chocolate 😉 ). But I can breath. I can lead a normal life. I can stop worrying about how long the next phase of easy breathing will be before I notice the hideous little symptoms returning, letting me know it is yet time for another trip to the hospital.

I think that realisation will take a while yet to sink in. Question remains: Do I consider myself cured? I do and I don’t. Yes, my illness phase is over. But, as this disease is such a rare occurrence and so under-researched, who knows what the long term prognosis is. But for now, I am grateful and relieved that my life is not dominated by my next visit to the operating theatre. Though I think I will miss the drugs 😉


Just Me Getting Emotional…..

Never regret a decision you have made. Never allow fear to overrule your desire to take risks, to prove it to yourself, to flee from emotional oppression. Never be afraid to follow the path of your gut feeling. You never know what it may lead to. Why am I saying this? Because I am living something connected to this indirectly as well as directly.

Four years ago a desire was stirred inside me. Something that washed me away as expectantly as it did without forewarning. An initial seed of escapism was planted and allowed to flourish. Attempts were made to knock me down, to discourage me from what my innermost instincts told me I had to do at that moment in my life. I was ridiculed, insulted and desperately hurt. It meant breaking ties of friendship, pushing back family all the while hurting others only to heal myself – emotionally.

I had no idea of what was to come in my life. I just knew I has to do this, to escape, to run away.

This ‘this’ was planing to uproot my entire life and move. Not flat, not town, but country. To go back to my past so I could go on with my future. It was tough, still is and to this day holds a tremendous amount of uncertainty. But also many positives I never even dared to imagine would come true in my lifetime.

Dealing with ISS as so many of you know, but most of you don’t, like with any illness, is a day to day challenge and it is a silent one. For me it lasted acutely for 13 years. And it seems to be coming to an end.

When I moved (back) to the UK in 2012 I had not for the life of me considered being introduced to the person who would come to change my entire life – medically speaking. One year after my relocation I was given the dangling carrot of stable health, stable breath. But what a journey I was going to have to take up for it, after the amount I had already had to shoulder so far. Having my throat slashed, a breathing tube put in, my body being pumped full of toxins all in the hope of successfully combatting this disease. And as scared, angry and emotional as I was I decided to accept and more importantly face this battle – again.

You get blasé about this things. Those of you who have had to deal with current medical issues, regardless of their nature, know the cynicism you develop. It is part and parcel, necessary even otherwise you would end up in utter despair. I received support I never thought I would and to this day I have not found the words to express my gratitude towards all those people that have stood by me in this battle.

Now I am quite possibly a mere single step away from getting a kind of normal voice back, from freedom, only having to return to the battle field for observations. This would NEVER have come about had I listened to my opponents 4 years ago. Had I succumb to the crippling fear always at the ready to lull me back to the dazed state of my then known comfort zone.

Despite all the general struggles (but also many little positives I am blessed with) my decision to relocate led to a victory I had never dared dreaming I would get (back): health. At least to as good a degree as I will ever get with this. The side affect with this victory is a life I can quite probably live to a fully normal extent.

Don’t ever be afraid to dream and to follow that. Don’t ever let fear take away what your gut is trying to tell you. Have faith, it will all work out even when you think it may not. You never know what positive lies ahead.

Phonating In Reverse

Well it has been a while. Life is an engulfing thing. I have had several weeks, no months now where I have been so utterly absorbed in its flow. This flow has caused some massive private stress of a kind, which could not be balanced by the many little positives in my life right now. This of course, has taken its toll on the progression of my speech therapy. Try as I might I was not able to unwind. It is certainly not a nice situation when you start the day with ‘I wonder what will go wrong with this situation’ and start ending it with ‘I wonder what awaits me before I rest my head’.

However, this stress factor has recently been plucked from my life and at my last speech therapy session I was complimented at how relaxed I was already looking with this positive outlook.

Wednesday’s speech therapy: Well, I have to say my therapist tried a different form of exercises with me that night. It was called ‘Inhalation-Phonation’. Yeah, it sounds exotic. And believe you me, I don’t want to be doing that in public out of fear some paramedic or doctor may think of starting instant CPR on me. Trying to phonate whilst inhaling sounds as though I am gasping for my last breath. BUT: It worked! I can actually engage my true cords this way. I can make a sound! Ok, not a very sexy sounds by all account. But A SOUND!!!! Naturally that is not the way I want to start speaking now. The object of the exercise(s) was to see whether I can or can’t use my true cords. It is also meant to be another way to strengthen them up. Whether or not this is actually working I don’t know, but even doing these exercises at home has made it possible for me to croak around happily albeit only at the time I am doing them.

Of course I have resigned myself to the fact that medialisation surgery will be inevitable. I was asked how that thought made me feel. It is difficult to describe that one actually, mainly because I have not given it much thought. I am so used to hospitals and operations that I am inclined to say ‘Hey, what’s another’. And of course, this procedure is an extremely minor one comparatively. How does this thought make me feel?

Excited in a way to be honest. And NO, not because of the drugs one gets. Excited because this really could be the end of it. The final step towards a kind of life I have been able to enjoy my first 20 years of it. And perhaps a fairly normal sounding voice, not this Yoda-like thing I am croaking out at the moment (though compared to the Darth Vader like noise I was making before the reconstruction I was reminded that at least now I have moved from the Dark Side the Force. Needless to say that one made me laugh).

My speech therapist has another patient and due to reasons of confidentiality I don’t know the root cause of his problem, however I was told he had been planning, and has now had the same operation that I would be going ahead with soon. She told me the difference in his voice was almost unrecognisable, she had to listen twice to be sure that it was not a well-audible relative that had answered the phone. That does sound reassuring.

I have my next follow up appointment fast approaching – in two days actually –  and I am assuming it will lead to setting a date, or at least planning for one where things will go ahead with this Isshiki Thyroplasty. As far as my airway is concerned, I have started gaining confidence in its stability. It feels open. My breathing is great. Let’s hope my perception will be confirmed. Until then I will – for now anyway – carry on phonetically inhaling.

Expecting Miracles Will Lead To Failure

Having been raised a Catholic I am of course not anti believing in miracles. Things can happen for which there is absolutely no explanation. Not that I have ever experienced one myself and like many others I am quick to say ‘Oh that’s a miracle.’

Let’s have a quick look at a rough Wikipedia definition of the word:

A miracle is an event not ascribable to human power or the laws of nature and consequently attributed to a supernatural especially divine agency. A miracle is sometimes thought of as a perceptible interruption of the laws of nature.

The word miracle is often used to characterise any beneficial event that is statistically unlikely but not contrary to the laws of nature, such as surviving a natural disaster, or simply a wonderful occurrence, regardless of likelihood. Other miracles might be: survival of an illness diagnosed as terminal, escaping a life-threatening situation or beating the odds. Some coincidences may be seen as miracles.

The chosen title for this blog sounds rather negative. Those were the words used by my speech therapist at her last session: ‘Don’t expect miracles, it will lead to failure’.

What she meant was: ‘Don’t expect your voice to miraculously change as this will be putting far too much pressure onto yourself, leading to unnecessary tension and your voice ultimately sounding worse that before’.

Great outlook isn’t it? Aim high but think low. This is where frustration comes in massively, which I in turn desperately have to try and harness. I can hear scraps of my voice during my exercises. Tiny, faint sounds that are trying their hardest to come out and with immense concentration I can even phonate to a degree. My problem is that I then go and expect too much of it.

Why is this wonderful little bit of voice not brave enough to stick around when I do really need it? My supraglottic cords have been so dominant these last ten years that my subglottic cords probably feel extremely intimidated by their brashness. All the while negative and pressuring external influences are working in favour of this brashness, making matters worse. Add a bit of miracle expectation into the equation and what do you get? A croaking that has been my defining trademark like, forever. At least that’s what it feels like.

So, what to do? First of all, don’t expect miracles! As much as I would love this to be a quick fix thing, I have to keep reminding myself that this is an endurance race and not a 100 metre sprint. I have to be patient (those who know me well are now laughing I am sure, as patience has never been that great of a virtue of mine, but I am trying). I have to keep reminding myself every day that I am taking baby steps here.

Next it’s practice practice practice. There is a big catch however. It is called embarrassment. I feel so silly doing all this ooooooooh-ing and aaaaaaaaaaah-ing and eeeeeeeeeee-ing when I am by myself, let alone with the risk of having someone actually hear me do it. And I honestly do not know why. Those around me know of my problems and that it is a necessary evil. Why can’t I just look beyond that mental road block? I really have to work harder on that one.

Last, but certainly not least is: Chill. Reduce stress. Tension. Try and find a “zen me“. Erm, beg your pardon: Where??? How??? Changing external stress, though difficult, is far easier than changing characteristics about yourself.

Yes, I very openly admit here now (after nearly 33 years of personal contemplation – and therapy) that I am a person needing to control every little aspect of her life – come what may. Someone who has insanely high personal standards with things she does, be it that they are realisable or not. I can’t sit still, not for long anyway. The concept of sitting there and doing nothing is so alien to me I wouldn’t even know where to integrate it into my life properly. I always feel I am being lazy and I don’t like that feeling. I am trying though, even if it is something as silly as having a cup of tea at the table reading a page or two in a book, greatly ignoring the call of something that has to be sorted out.

Ok, ok, so I do give in to the calling quite quickly but even here it is baby steps. I just have to keep walking.

I am resigning myself to the fact that the vocal cord surgery is inevitable. Not because I am seeing it as a possible quick fix solution. If it were just that I would have had it done ages ago. After six weeks of speech therapy and exercises I can safely say (and with the assessment of my speech therapist) that this alone is not going to do it. My voice has been through too much in the last ten years. But hey, to use the Guru’s words: ‘Compared to what I have been through, it will be a walk in the park’. I am in a good place right now. I am where I need to be. And this too will get sorted. Even if it isn’t because of a miracle. But, perhaps the actual miracle was being introduced to the experts I am now seeing for this, who seem to be leading me to the end of it all…

One Step Forward, Two Steps Back

Utter frustration, that’s all I can say about my current vocal situation. Last week’s speech therapy was cancelled which was really irritating as I was desperate to discuss something important with my therapist. Since Monday last week I have noticed my voice “seizing” up half way through my working or speaking afternoon. This could be attributed to the fact that I have a profession where speaking is essential. I guess the private chit chat could be totally omitted if necessary, however I feel this would be one of the worst ways to do the job I do. For me, a patient isn’t merely a set of teeth coming through the door, but an individual with a life, stories to tell, personal circumstances be those happy or frustrating. I love the regularity of my job. When I see people several times a year there are many events that take place in their life. And not just that, building a rapport means they find out a lot about my life as well. And, just like me, they are curious about things that have happened. Thinking of nervous patients, you can’t just get on with things. You need to talk to them, ease their anxiety by either explaining in detail what you are about to do and why or just talk trivial things throughout the appointment.

It also doesn’t help that I have developed a pretty chesty cough. And funnily enough, that has been going on since last week Monday as well. Every time I have a coughing fit, my laryngeal area tightens up and it takes ages for me to release the tension. Of course, this new onset of minor illness, combined with a child that is unwell, means that I don’t seem to have any opportunity to fully recover from things. It’s just one little thing after the next after the next after the next after……

Things at home are somewhat interesting, for want of a better word. I have welcomed a different circumstance into my life in hope that issues revolving around my son would perhaps improve (I know you are curious so, to satisfy your need to know, it is to do with child care). Generally it is working out well for my son. I am finding it rather difficult to adjust to the situation that I am having to deal with a much higher level of dependency, or so it seems, than I thought or would like for that matter. The situation as such is not a bad one, on the contrary. However, having to reiterate so many little, for me normal ‘open your eyes and just get on with it‘ stuff amongst other things is actually proving counter productive in this whole laryngeal relaxation. I was told you can literally see my lower jaw tensing up just talking about it.

That is the operative word here. I am generally tensed. That is the conclusion from the previous session. And I can just hear most of you say: ‘Sweetheart you have only just noticed that?‘ My answer to that is: well, no I haven’t. I know I am generally the type of person who tenses up quickly when situations are relatively stressful. Stress doesn’t bother me as such. I actually work better when there is a little bit of pressure present. Studies have shown that it can be a motivator. What I hadn’t realised was that this tendency to tense up was affecting me as much as it apparently is. And particularly in the area it is. 

My question of the day: how to relax. Self-care is a big thing I think. And I do try and fit at least a bit of it into my day, be that by running (ok, stupid amounts of it at the moment due to training for the marathon), a hot bath, yoga or just enjoying a cup of tea or coffee with as little distraction as possible. But, in this case, I don’t think it is the kind of self-care that is going to do it. I keep thinking of work-life balance, work-work balance, life-life balance, mum-individual balance… where do I find my balance? Where in my day, my life can I make changes that will affect me positively and help me to heal? Mentally I have been working hard and it is helping. But physically, I feel so far from it. And I am not sure how to stop this ‘one step forward, two steps back‘ cycle I feel I am in. I try not to let it frustrate me, but it is hard.

Is It Surfacing?

Wednesday was time for speech therapy session number two. Leaving the session last week I was seriously asking myself where I could do these darn exercises without feeling like I was making a complete idiot of myself. I am generally always around people. Thinking of it in detail makes you come up with the most absurd places. For instance under the shower in the morning or on the way to work in the car just to name but a few. I know what many are going to say: ‘Why are you feeling silly about it?‘ Do them and you will know why. And as much as I try to tell myself I shouldn’t, the more I kind of do. But thankfully I have worked my way around the problem. For now anyway.

There are a few things I have noticed very quickly in the last week. Things that are rather obvious when you spare a minute or two in contemplation. The region of my neck is incredibly tense. And to think that for years it has felt absolutely normal to me in that posture. Now that I am learning to relax my neck with help of various exercises and techniques I am amazed at how wrong that area had been aligned. Also at the moment, my voice is more strained after a long working day as well as if I try to make it louder than it can be. And of course, it depends on how hydrated I am. The more water I drink, the easier it is to keep my voice balanced. With dehydration it sound scratchy.

I have never been one to drink enough, that is admittedly one of my vices. But hell I can tell you this revelation (though more than obvious) has been quite good at motivating me to keep my fluid levels topped up. Yes, some days are easier to manage than others, depending on how busy I am, but I have found that if I keep my water directly by the computer, which I go onto about every half an hour to type notes, I find myself taking a few sips whilst doing so. Ok, this is making me run to the loo about every 2 minutes at the moment, but that should hopefully get better over time once my body get’s used to the increased water supply.

When at home I try to integrate my son into the exercises. and appart from loads of fits of giggles he does manage to help me quite well. I put him in charge of checking that mummy is going things correctly. However it kind of went pear-shaped when I had to play around with the word ‘moon‘. Now, I know he is only just six, however still old enough to know not to make fun of people, particularly in situations where matters of the health are concerned. I also know my time in hopsital and probably now as well, was a much more difficult to cope with than one would think and he has done, and still is doing, extremely well. But I do think difficulties need to be respected, even if set in humorous situations. So we did have to have the odd serious word about what is ok when helping mummy with this and what can be hurtful. Thankfully I have a bright child very quick on the uptake.

Last week I posted on my Facebook group page that I thought the sound of what is coming from my neck is kind of trying to resemble a voice. I wasn’t sure whether my cords have felt disturbed in ther comfy long-term doze and thought ‘Oh ok then, for peace sake let’s just croak a bit and be done with it‘ or whether it was actually starting to become somewhat subglottig rather than supraglottic. The powers of wishful thinking are huge when you desperately want something. But, low and behold, my therapist seems to think that the sound I am reproducing is sounding more subglottically than before. There is less strain to my voice, with phonation increasing during my last session with her.

We talked about the general situation and yes, she also seems to think that medialisation of my vocal cords, proposed by the Guru himself, will probably be benificial, but applauds the approach of not jumping to it straight away. There is too much base work to be done before attacking the cords at the moment. She has numerous patients with vocal cord palsy and said the medialisation was something like the icing on the cake. Of course, after surgery speech therapy should be continued to solidify any improvements already achieved and also to learn how to use the new position of the cords.

One thing I dared to ask was my singing voice. The speech therapist said on the patients where the surgery was successful, there general pitch and vocal range returned – perhaps  not to what it was before, but it returned. When I told her about my pleasure for singing and asked whether or not I would just have to live with the fact that I had no vocal range what so ever I was told that, even though it would still be a long way off, there is no reason why it should be impossible. She has had patients that were singing again. I don’t want to come across as being too over-enthusiastic but OH MY GOD!!!!! The thought of possibly using my voice like that again is totally overwhelming. And yes, I am fully aware that there is a lot of work involved (and DAMN I am going to do it!!) and I also know that I won’t be sounding like Sarah Brightman in this life time, but to just be able to sing again… Even if it is just under the shower… That would be a dream come true.

For now, I just have to let my voice surface and be happy with even the smallest of improvements. And believe you me, I am. I cannot tell you how much.

Shhhhh, Fffffff, Ssssss, Zzzzzz – With a Watford Accent

I mentioned in one of my previous blogs that I had forgotten how silly speech therapy makes you feel. Speech therapy makes you feel really really really silly. I was guided through various relaxation and phonetic exercises, however found it extremely difficult keeping a straight face.

Wednesday I had a day of hospital visits. It started off by trekking to my medical home base in London – Charing Cross Hospital – again. So it was the usual waiting game though I have to say I was extremely impressed that I was called in a mere 10 minutes after arriving. I was called in by a registrar that looked too young to be playing doctor. But he was very nice and I have to say very gentle when sliding the flexible endoscope through my nasal sinuses.

With my existing vocal issues he was unsure on what exactly to recommend so he called upon the Guru himself who made a personal appearance. He even took the time to stick the scope down my nose again, being not quite as gentle as his predecessor, but still careful enough for me to not mentally punch him. His summary of my airway were these words exactly:

The airway looks brilliant actually

Sufficed to say I did a little mental happy dance around the clinic. Ok, so maybe it was a H U G E mental happy dance though considering the verdict it was fully reasonable. Were I not abstaining from alcohol for the next 4 months I would have cracked a bottle of bubbly to toast the news (one would think I had won millions in the lottery – though I guess in a way it is like winning the lottery, even if it is “only” medically, though absolutely priceless).

The only thing that made me give him an evil eye was the fact that he suggested an Isshiki Thyroplasty (type 1). For those who are particularly interested:

More surgery… yay – not! The good thing is that there is no real rush to do this and compared to what I have already been through, ‘a walk in the park’ to use his words. Being a surgeon ready to slice and dice it seemed as though he would have loved getting me back almost next week to carry it out, his reason being he was thinking of my working situation in particular. Thankfully we could agree on postponing until May, when I will have put my body through a torturous 42 km run through London. This will also give speech therapy a chance to hopefully improve things without having to take a scalpel to hand.

On to speech therapy. Thanks to a power cut half of it was carried out in darkness. But necessity is indeed the mother of invention, in this case creativity, so the only illumination came from the flashlight of my phone. The session started off with listening to a recording of my original voice, kindly sent to me by my ex-boyfriend. Apparently something like that is a bit of luxury as it is rare to have an original recording of a voice prior to issues that have been going on as long as mine.

I was moved on to some relaxation techniques of the neck and upper spine. Sitting there I thought I could quite happily carry on doing this without even feeling silly about it. But of course this state of not making an idiot of oneself was not to last. During the first phonic exercise, the Ssshhh-sound I found it rather difficult to contain myself and ended up in fits of giggles. I had exactly one thought running through my mind: ‘How on earth am I supposed to do this properly at home?‘ You honestly feel like a complete prat sitting there, going ssshhh, ffffff, sssss, zzzzz, moon and so forth. I think I need to hide somewhere when I do these. But as the saying goes ‘No pain (in my case embarrassment), no gain.’ And if I want my voice back up to scratch I will have to bite the bullet and just get on with it.

The Watford accent comes in with exercises interrupting the normal flow of breath. It basically means omitting the ‘t’ when saying things like ‘butter‘. Oh joy, just the thing I am desperately trying to get my son not to do as he has picked it up at school and now I am the one actually having to do it. It will be a tricky one explaining that to him, why mummy has to do it but he shouldn’t. I can already see the discussions coming.

One rather depressing thing I noticed very quickly is that I have totally unlearned how to speak. By that I mean properly. My voice is currently supraglottic – above the vocal cords – which is causing the strained sound in my voice. And I have more than likely trained myself to do that back in 2004 when I had my first tracheostomy. So 10 years of incorrect speaking. It is going to be a long journey re-training my actual cords. And yes, I will very probably need the final procedure, but I am positive that, along with regular speech therapy sessions will help create a fairly normal if husky voice again.