I'm scheduled for my next Botox injection Jan. 6th with Dr. Bastian in Chicago. Normally, I get injections in both vocal cords (AD type). I remember reading a couple months back that some have had good success with unilateral injections in multiple locations on the same vocal cord. Does my memory serve me correctly? Can anyone share his or her experience with me on this type of treatment? I'd like to discuss it with Dr. B. when I see him next.

I'm a 40-shot veteran. Botox works better for me now than it did in the early days because the doctors (and I) have played around with different alternatives. I'm envious of the few SD-people I know who have a shot and it produces a normal-sounding voice straight away which lasts until their next shot - in my case I've had to deal with the breathiness issue.

When my doctors, several years ago, kept lowering the dose of bilateral injections to help with breathiness or 'loss of voice', the result was that the benefit didn't last as long. For me, getting bilateral shots was lose/lose. Still breathy, because both cords were being injected, and the spasms returned quickly due to the low dose. At one point they repeated shots (dose was about 0.3 units) after only 6 weeks - I wouldn't recommend that generally as too frequent injections might raise the risk of developing immunity to the Botox.

For some of us (not all) having unilateral injections resolves the loss of voice problem straight after Botox, and a relatively high dose (10 units in my case) ensures the benefit is still 4-6 months. I am currently very satisfied with my treatment regime - which is unilateral (2 sites in right cord only) and 10 units every 6 months.

To me anyway, it is important that the SAME cord is injected each time. When I tried unilateral but alternating cords - ie left/right/left/right .... then I found the uninjected cord was still fairly weak from the previous injection and I was still too breathy. Another advantage with unilateral injections is that a higher dose can be used and this, in my opinion, means the shot lasts longer. A slight refinement to this unilateral approach is that my doctor injects two sites in the right cord - this spreads the Botox around more and acts as an insurance policy in case one shot is in the wrong place.

Good luck! I can't think of a better doctor to be treating your SD than Dr Bastian.

I, too, was scheduled to receive a botox treatment from Dr. Bastian on the 6th, but due to my teaching schedule, moved it back a week. I decided to see Dr. Bastian last fall after reading some encouraging posts about him. After meeting with him, I would never hesitate to travel the 3 hour distance for treatment. He is extremely knowledgable about SD and sensitive to how this disorder effects our lives. So thanks to everyone who has mentioned Dr. Bastian in their posts!

Bill, please let us know how your treatment goes - if you choose to do a unilateral shot and what Dr. Bastian's thoughts are on that method of treatment. I've been considering doing the same, as it's been difficult to get through the breathy phase and teach to a classroom of 28 students. It causes a lot of frustration, and I hate to take too much time off of work after treatments.

Good luck with your next treatment!

I don't remember reading anything about side effects after an AB injection. Can any of you give me an idea what to expect?

I had my Botox injection today with Dr. Bastian. We discussed trying a unilateral approach this time instead of my regular bilateral shots (because of my "dreaded" 4-6 week weak and breathy post-Botox period). I showed him David Barton's email to me (see the B.B. December 22 posting). He said it was definitely worth a try. When I asked him if there were any benefits to this approach he said it all depended on the individual given the unique way SD affects each person. Some people did notice less subsequent breathiness. I said I was willing to give it a chance. He did "up" the dose for that one shot. It's too early to tell anything yet but I'll keep you posted. I’m always hopeful!

I know what you mean about teaching. I'm a college librarian and find it very difficult, frustrating and embarrassing in not being able to communicate effectively to a class when I'm doing library instruction. Faculty and committees are also trying experiences too!

Thanks the reply regarding your treatment. I'll be curious to see how the unilateral injection works for you. Have you noticed any significant differences at this point?

It must be tough to be in a field where you are required to speak to groups of adults on a consistant basis. I have put my graduate work "on hold" for that very reason. Although I'm pretty critical of my voice, my students, being elementary-age, are very accepting of my voice and have grown used to it. So I don't have to deal much with the embarrassment issue - only around colleagues.

It's amazing how much I took for granted before this disorder. Now I am so thankful for those "good voice" days, where I can go about my job and the rest of my life as usual.

Good luck with your treatment results.