A couple of questions regarding your oral injections ...

Do you have them under general anaesthetic?

If not, what is done to deal with the gag reflex?

Thanks!

The 'oral injections' here means that instead of the needle being inserted through the skin (per-cutaneous) at the front of the throat (larynx or Adam's apple area) the needle is being inserted through the mouth and then over the tongue and down the throat until the tip reaches the larynx - then the doctor would inject the vocal cords from inside the throat.

My questions to James related to whether this needed to be done under general anaesthetic, and if not, how did he tolerate the gagging reflex or how was his gagging reflex suppressed.

In passing, I would note that this 'per-oral' method is not used by the overwhelming majority of SD treatment centres. At symposiums when this topic has been raised the experts have said that the success of the Botox shots is unrelated to the method used (per-cutaneous or per-oral), and that most patients find the per-oral method hard to tolerate, and that repeated general anaesthetic every 4 months or so just for Botox injections would not be recommended. A skilled and experienced physician with a good working knowledge of the larynx knows where to put the needle coming in from the front (per-cutaneous) and the emg guidance provides confirmation that the needle is in the right spot.

I truly believe in "whatever works" but, anticipating possible Botox treatment for myself, the "patient comfort" issue you mention is paramount.

Since my vocal surgery years ago, I have a major (**MAJOR**!!!) gag reflex. I can't even swallow pills anymore (the inability to swallow pills only started with my vocal surgery in 1996). I barely got those Neurontin pills down, and they are capsules and smoothe. Other SD'ers I've met have said this is an issue for them also and the description seems to generate a gag reflex, expecially in those of us who already have one.

James...I know alot of people who travel cross-country for their shots, so might this not be a possibility for you? If I had a treatment plan (and someone, a doctor) which worked over the years, I'd be a bit reticent to start anew. Just my personal opinion. Can you fly back to your routine doc every few months rather than begin anew?

Good luck,

This is great news and when you mentioned the possibility of having "mixed" recently on AOL "Voices," I was hoping to hear a report like this. The way you've described how your voice sounds on chat definitely seemed like it was a possibility.

Congratulations on moving on with your treatment and being creative with your doctors! I'm looking forward to hearing how your current injection-cycle goes. My theory is that there are alot of folks out there who have *mixed* but don't know it yet. It's so complicated to diagnose and "mixed" confuses even the experts. Keep us posted.