Spasmodic Dysphonia Bulletin Board

unilateral injections vs. bilateral
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Posted by: linbobd ® 12/20/2006, 10:33:57

I've been receiving botox injections for the last five years. At first, I had good results, but for the last year, it's been frustrating. On Oct. 1, I had a unilateral injection of 12.5 -- no breathiness, and limited relief for about 6 weeks. I went back yesterday for a booster and he did another 12.5 unilaterally in the opposite side. It's too soon to tell how this will work. It seems like I'm going to get injections every 3 months. I'm so tired of not having a good voice to talk. My job requires that I interact with the public, both in person and by phone. People that I see regularly know about my sd, and are patient with me. Is it possible to become immune to botox or does the dr sometimes miss?? linda

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Re: unilateral injections vs. bilateral Re: unilateral injections vs. bilateral -- linbobd Top of thread Archive Posted by: NWallin ® 01/03/2007, 11:33:34 Hi Linda, I think that docotrs definitely sometimes "miss". Giving injections is an art as well as a science in my opinion. Unless they are actually visualizing placement of the needle, the needle could very easily have passed through the muscle, or just touching the tip, which would still yeild a positive EMG. I have had several injections over the years that either did not work at all, or gave me extremely limited benefit. But we try, try again and get a succesful one the next time. (A lot of times not as soon as I would like, but that's another gripe haha) I would suggest having an open communication with your doc and let him know what your concerns are. Maybe go back to the bilateral and see if that works better for you. Unilateral doesnt work better for everyone as we are all different. Play with the dose a little bit. I think getting the perfect dose is a lot of trial and error. Let us know how it goes! Take Care Nicole | Recommend | Alert Where am I? Original message Top of thread Current page Re: unilateral injections vs. bilateral Re: unilateral injections vs. bilateral -- linbobd Top of thread Archive Posted by: keith ® 01/03/2007, 20:03:16 Hi: My doctor does not personally believe in immunity to botox, and feels that if a patient responds positively to botox, there is no reason not to expect continued benefits from subsequent injections. Correct placement into the muscle is indeed a critical element and, yes, it is possible for misses to occur, especially in cases where direct visualization is not possible. Such is the situation, for the most part, with shots for abductor, where the botox has to go into the PCA's. Even with the scope, my doctor can see the needle pass through the larynx and aim towards the muscle, but can't fully see where it's supposed to go. The skill and expertise of the administering physician is certainly a crucial part of the whole equation. Best, Keith | Recommend | Alert Where am I? Original message Top of thread Current page Re: unilateral injections vs. bilateral Re: unilateral injections vs. bilateral -- linbobd Top of thread Archive Posted by: mdubovick ® 01/04/2007, 20:08:44 I completely agree with comments in the posts done by NWALLIN and KEITH. It is possible to have a good voice with minimal disruption if you can arrive at the optimal Botox dose. The goal on Botox shot dosage is to use the lowest possible effective amount that will prevent the breathy after-effects. Unfortunately only trial and error until you can build up a history will give you and your doctor enough information to decide what the optimal dose should be. This practice should be able to give you a good voice to talk on an ongoing basis. Lastly, I'm told that only a very tiny portion of the population is immune to Botox but it is possible. There is a blood test for antibodies that can be sent out to a special processing lab in Massachusetts. Your doctor should know the details on that, should the need for testing ever arise. | Recommend | Alert Where am I? Original message Top of thread Current page Re: unilateral injections vs. bilateral Re: unilateral injections vs. bilateral -- linbobd Top of thread Archive Posted by: jerrylee ® 01/05/2007, 09:49:09 After many years, i have the dosage down to a relatively low level which seems to work best for me, but I must admit that the results can vary with each injection. Sometimes no breathy voice, sometimes a breathy voice for a few weeks, and once or twice, a breathy voice for 5-6 weeks. the point is.............this is not an exact science. The strength of botox starts changing as soon as the bottle is opened. It is an extremely minor change, but it does. When I get my botox, the bottle could have been opened from anywhere between 1 minute to 4 hours. Hopefully you can get it down to a level that is fairly consistent. good luck.....Jerry | Recommend | Alert Where am I? Original message Top of thread Current page