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Posted by: Vash ® 09/17/2008, 20:43:04 |
I read a few posts about Botox injections not working properly because maybe the shots aren't injected in the right place. From what I read, the muscle areas are small and can move away from the needle point if there's slight movement in the throat. My question is, why don't all doctors use scopes down the throat to see where exactly they target? Those who where lucky to have a scope used, please share the result after your injection. |
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Posted by: Hoarse Whisperer ® 09/18/2008, 11:59:53 |
Since my diagnosis in 2003, I've had Botox injections from three different ENT doctors. Two do the injections through the front of the throat using an EMG (electromyography) guided needle. One does the injection down the throat. All three ALWAYS used a flexible laryngoscope to watch what they were doing. Lori
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Posted by: NYer AdSD ® 09/22/2008, 20:08:04 |
I was scoped before; can't recall if I was scoped during injection. I do remember him affixing something to my neck, on both sides, those round things used for EKG? He stuck those to my neck, then he could see an outline on the screen and he lines it up, tell me don't swallow, then inject; I don't remember at all if the scope was in or out; was trying to block out what was going on and the needle going into my neck for the first time. |
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Posted by: Keith ® 09/23/2008, 18:24:27 |
Lori, Curious....who administers your injections through the front? It sounds like you get the method originated by Robert Bastian, which my doctor also uses. Many inject on the side of the neck. Do you get lidocaine sprayed down the throat and also some anesthetic injected at the insertion point prior to the injection? If so, it's the same method used by Bastian. Take care,
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Posted by: Keith ® 09/23/2008, 18:21:00 |
I also get 'translaryngeal' injections - through the front of the throat area - and my doctor always uses a scope to see where the needle is going.
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Posted by: speechless in SoCal ® 09/24/2008, 16:18:41 |
Hi Vash, I’ve only had three shots so far, one with the scope and needle, two with the EMG needle only. Even though a hate the procedure in general the needle alone (no scope) is much preferable for me. It didn’t seem to take any less time to find the correct spot with the scope and needle. It was difficult for me because I just felt like it was too many things going into my body at once (with scope). I do not understand when posters talk about the procedure down the throat. Like everything else with SD everyone seems to have had different experiences. |
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Posted by: allysonmihalko ® 09/24/2008, 20:00:42 |
I'm fairly new to this website and will be getting my first botox treatment next thursday. I feel confident in my ENT because I was lucky enough to get my diagnoses on the very first visit. He told me I will have a general anesthesia and the botox will be injected by going down my throat somehow. He said that no doctors here in Colorado Springs do it the other way through an injection in the neck and that if I wanted it done that way I would have to drive to Denver to have it done. |
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Posted by: Hoarse Whisperer ® 09/25/2008, 01:20:57 |
The two doctors who used injections through the front of the throat (translaryngeal - meaning through the voice box) were both at the University of Texas Southwestern Medical Center in Dallas. The original doctor was Robert Sinard, who has since moved to Vanderbilt in Nashville, and my current doctor is Barbara Schultz. Both are wonderful. Because I have the abductor form of SD, the PCA (Posterior Cricoarytenoid) muscles are injected. These muscles are located behind the larynx. This is basically what happens: The EMG (electromyography) sensors are placed on each side of my neck. Numbing medication is sprayed down my throat and into each nostril. The video scope (flexible laryngoscope) is inserted through my nostril until the vocal chords are visible on the video screen. Numbing medication is injected under the skin over the front of the voice box (larynx). Numbing medication is then injected/squirted into the voice box, causing a cough, which spreads it around and numbs the entire lining of the voice box, which is otherwise very sensitive. The EMG guided needle is then injected all the way through the voice box and out the back. As the needle passes through the back of the voice box, it should be in the PCA muscle. The EMG verifies this. My left PCA muscle is injected (current dose is 10 units). Lastly, my right PCA muscle is injected (current dose is 15 units). Usually I don't feel much of anything. Sometimes I have felt a slight sting as the Botox is injected into my right PCA muscle. My right side is the most spastic. When it does happen, it's kind of like a "hurts so good" sensation, similar to when pressure is applied to a muscle spasm. Then I'm done. The whole procedure takes between 5-10 minutes, although I'm there a lot longer because we both like to talk. I don't get a HUGE improvement with my voice, but the spasms are gone within 48 hours. I have really bad spasms that can actually interfere with my breathing, so it's worth getting the Botox injections just for that. I consider any improvement with my voice to be just an added bonus. Lori
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Posted by: Vash ® 09/25/2008, 08:36:47 |
Thank you for the details! Seems that your spasms fade faster than others. I guess precise injection really makes a time difference. |
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Posted by: BRife ® 09/25/2008, 11:25:28 |
Lori, I use Dr. John Truelson, who is Dr. Schulz's partner at UTSW, and he does it the same way, only without the numbing spray first. Also, my understanding, from talking to Dr. Truelson, is that they will be soon getting another doctor who will handle both of their SD cases. I go back in October for my next injection, so we'll see if the new person is there yet, and how he/she does it. Bryan
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Posted by: Hoarse Whisperer ® 09/25/2008, 14:09:11 |
Dr. Ted Mau has already joined the staff at UTSW. He is awaiting approval from all the different insurance companies before he can start treating patients. It's my understanding that Dr. Mau will take over Dr. Truelson's SD patients and that Dr. Schultz will continue to see her SD patients. It's also my understanding that Dr. Mau was trained by Dr. Sinard, so the procedure will most likely be the same. Lori
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Posted by: jerrylee ® 09/26/2008, 10:17:40 |
Would you mind contacting me via my email address? Thanks J. Lee
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Posted by: Hoarse Whisperer ® 09/27/2008, 00:56:15 |
Jerry, Who did you want to contact you - me or Bryan? Lori |
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Posted by: Sojourner ® 09/27/2008, 13:05:01 |
My doctors use an EMG machine and inject the needle through the front of my throat, just under the Adam's apple, while I am sitting up. They do not use any type of scope in addition. I have had three bilateral injections. I have received tremendous benefit every time. The time of onset of the side effects, difficulty swallowing and breathy/airy voice has been the next morning, the next evening, and the evening of the fourth day after the injection. For each of my injections, my dosage has been reduced. I have experienced a lesser degree of side effects both in intensity and duration each time. |
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Posted by: dbb9333 ® 10/06/2008, 19:30:36 |
I have had both trans tracheal (needle through the neck) and by direct laryngoscopy. I prefer the direct. Never a miss ever and the botoxs works everytime. Use to have to wait three days to see if it went in the right place before and I dont have to take as much botox as before. |
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