I'll have a go at answering your questions.

I wouldn't give up on Botox shots too soon, particularly seeing you have AD/SD. I would think your injection program could be tweaked a little - maybe a lower dosage, maybe unilateral shots, etc to reach a point that suits your individual case. The best way of describing 'breathiness' in an SD context is to say that when you are speaking post-Botox you will waste a lot of air (the voice is based on breath support) and will need to pause frequently, take in more air, and resume speaking. So you will be 'breathy' in the sense you have to take more breaths. If you talk for a long period, post-Botox, you might find you hyper-ventilate - if so, stop talking for a while. The post-Botox voice, although smooth and free of spasms is also husky and difficult to project, especially over noise.

Two main surgical techniques have been discussed on the BB - these are thyroplasty and the SLAD - selective laryngeal adductor denervation - surgery. Use the search function to investigate these ... and they were also discussed at the last NSDA symposium in Scottsdale, AZ. There is a write-up about this under "Symposium Reports" at www.dystonia-support.org If you decide to go with surgery please make an informed decision based on the knowledge that there is a risk that the SLAD surgery may leave you with NO voice - that has happened to two males who post on this BB.

SD is not usually progressive, although it is a relatively unstable disorder (in my opinion) and the symptoms can vary in intensity from day to day, month to month etc. It usually reaches some kind of plateau. It is unusual, but not unknown, for SD to go into remission. In some cases neighbouring muscle groups can become affected. The reason - "spasmodic dysphonia" is the term given to the voice you produce but the actual disorder is laryngeal dystonia - the brain is sending inappropriate signals to the vocal cords. So a few SD patients can go on to develop cervical dystonia (aka ST) where there is neck muscle involvement, or oromandibular dystonia (muscles around the jaw/mouth) etc. It also works in reverse - the dystonia in an ST patient for example can 'spread' to involve SD.

I personally haven't had any benefit from acupuncture - I tried it in the early stages. If you decide to try it, set limits on how long and be prepared to make a decision to stop if/when you feel it isn't helping. Alternative therapists will often tell SD patients they can help - they may genuinely believe that, but it is also how they make their living.

If you get the opportunity to travel to an NSDA symposium one day I'd suggest you take it - it's a great way to meet fellow SD'rs, swap experiences and also get updated on the latrest expert medical information about our disorder. It sounds like you are in the New England area, so it wouldn't be too far for you to travel to the NSDA symposium in Washington DC next March - this will be the main one for 2003.

Keep up your pursuit of knowledge about SD - the more informed you are the easier it is to deal with!

Best wishes