Friday, March 04, 2011

In which Jo feels rather more optimistic. (Now with improved spelling!)

Cancery McCancersons update! Well, not really. More like Evil Space Creature Obturator Update:

The interim obturator is GO. Dr. Obturator Elf is fitting me for a functional tracing later this month, and then the traced device will be casted in acrylic, and I'll have an entirely new roof-of-mouth.

Now, for the preceding in English:

When somebody like Dr. Crane comes along and removes the top of your piehole and most of the back of your throat, things change. Chief among those changes is your subsequent inability to talk without sounding like you're stuck at the bottom of a well with both a cleft palate and a sprained tongue. Seriously, I sound better without the prosthetic than I did just after surgery, but I'll never be able to be intelligible without it.

Also, because the throat is made up of a number of layers of muscle which heal at different rates and adapt to the obturator/speech bulb combo in different ways, there have to be different devices (I love that word: device. Sounds like an evil 1950's scientist is working on me) to cope with those changes.

The first obturator, the one that looks like a big pink bug, is called the surgical obturator. The second, the one I'll be fitted for in a couple of weeks, is an interim obturator. The big differences between the two are materials and size. The first obturator was/is made out of a softer material, to help coax the musculature in the back of my throat into the shape it'll need to be in to handle the later prosthetics. It's also freaking HUGE, because, well, there's a big ol' hole in the back of my head.

This second obturator is already smaller, and will be made of clear acrylic. It's not porous and will therefore be much more hygienic in the long term.

The interesting bit, though, is how the whole fitting process works. Check this out:

The back of your throat is really mobile. It changes shape when you talk, eat, swallow, sneeze, or even turn your head. Even going from sitting to standing changes its shape a bit. Therefore, you can't have a solid, smooth piece of plastic sitting back there; the muscles wouldn't "grab" right, and the plastic would slide around. You'd have leakage through your nose and sound, again, like somebody with a badly stuffed up schnozz who's at the bottom of a well.

Unfortunately, because you're making something that has to last for months or years, you can't have a nice, smooshy lump of, say, Silly Putty atop the obturator. It has to be rigid. The way it gets fitted, then, works like this: You wear the preliminarily-shaped obturator with a thick layer of wax on it for a number of hours, going along in the noiseless tenor of your way, and the wax shapes to the average configuration of the surgical deficit (or "big ol' hole").

In a way, it's like any other prosthetic: you take the average of all the activities that the device will help you with, and try to incorporate those activities into the device's finished shape. The difference is that this prosthetic is much smaller than an arm or a leg.

During the last appointment, Dr. Elf made a general outline of the big ol' hole with thermo-reactive plastic mixed with diatomaceous earth. (Why diatomaceous earth, I don't know; I think it has something to do with stabilizing the plastic, kind of like cornstarch thickens gravy.) The mixture that got globbed atop the base of the obturator and shoved into my mouth tasted just as lovely as you might imagine, but we ended up with something that sort of looks like the back of my throat, but about fifty percent smaller than it was just after surgery. The wax that Dr. Elf then used to make a preliminary functional tracing thankfully has no taste at all--and showed that the angles where my throat muscles come together have closed substantially in the last few months. The new obturator will be about half the size of the old one.

This is exciting as hell. I'll never be able to function without a prosthetic palate, but at least it won't be something that needs its own seat on an airplane. It also explains why my voice quality went from okay to fantastic and then back to sort of nasal and gurgly: the old prosthetic (the one I'm still wearing, the pink space bug) is now too big, and gets knocked around by my toned, rippling throat muscles. I have the equivalent of a Fitness America contestant in the back of my throat.

The weirdest part of all of this is how it's changed the shape of my face, to talk with this obturator widget. For a while, I had an even bigger set of lips than normal, because talking took a lot of work, lip-wise, to enunciate properly. Now I've got a sizey lump of muscle that looks a bit like a double chin, since it takes more tongue-muscle at the moment to talk/swallow/whatever. Dr. Elf assures me that all of this will fade back to normal as the process continues.

I'll post pictures of the two obturators compared and the second one in process if he'll let me photograph them. It's really cool.

And that, Chickadees, is why I feel vaguely more optimistic these days about this whole shebang.


Allison said...

Wow. That's a lot of stuff happening in your head. I'm glad you're progressing, and the device is shrinking. You're right, device is a cool word.

bobbie said...

I'm glad things are going so well for you!
Fascinating ~

Eileen said...

With bobbie - glad and fascinating!

Silliyak said...

I think about those who went before and how they (the docs etc) came up with these procedures.

terri c said...

In the early 1970's, I was told, the word "device" was used by the Department of Defense as a euphemism for "bomb or part thereof." Sort of a kinder, gentler word... Glad for the progress!

inkgrrl said...

Neat! And YAY!

Jo said...

Terri, that's exactly what I was thinking of. Maybe I could P-shop a picture of myself waving my cowboy hat as I ride a falling obturator?

terri c said...

OH yeah. That would be a great pic.