Scott Flanagan remembered how the symptoms began.
It was June 2017.
“I thought what I got was bad laryngitis,” he said.
So the Fremont man wasn’t concerned and figured his voice would improve with time.
But over the course of two weeks, his voice became very soft and extremely choppy. He couldn’t say a full word without it breaking into three separate parts.
Flanagan’s voice is important to him. He teaches quilting nationally and at Country Traditions in Fremont, where he is the creative center coordinator.
He went to Midland University on a voice scholarship and sang in the college choir before graduating with a business administration degree in 2007. He’d sung in the choir at Fremont’s Sinai Lutheran Church since college.
Flanagan was a tenor with a loud voice that could fill a 200-seat lecture hall without a sound system.
But in 2017 he was losing that voice.
Flanagan tried other options, before having a 2018 surgery that is helping him regain it.
As his voice deteriorated back in 2017, Flanagan first went to a doctor who prescribed steroids and antibiotics. When his voice didn’t improve, he saw a specialist who prescribed medicine for acid reflux and put him on voice rest — with no talking — for four weeks.
He taught classes by writing on a dry erase board, thinking his voice would improve with rest. It didn’t. In fact, it probably was worse.
“At that point, I was scared,” he said. “I was starting to think something was really wrong.”
Flanagan said he saw an Omaha laryngologist, Dr. Christopher Bingcang, who confirmed he didn’t have cancer, and narrowed the diagnosis to one of two conditions – either muscle tension dysphonia or spasmodic dysphonia.
Muscle tension dysphonia could be treated with Botox injections or speech therapy. Flanagan first opted for the speech therapy, but later augmented that with Botox injections in his vocal cords.
Instead of having injections in the front of his neck — which could have resulted in missing the cords — he selected the type in which a scope was put through his nose. A numbing agent was sprayed through the scope.
After that, a needle was put down the scope and Botox injected through the needle directly into the vocal cords.
Flanagan would have Botox injections and speech therapy from September 2017 through September 2018. He had the injections every three months. Each time, the dosage was increased.
He saw some benefit with the injections, which after insurance, cost from $1,500 to $2,000 each time. He dealt with swelling and swallowing impairment, eating only ice cream for the first three to four days after a treatment.
In the meantime, Flanagan was diagnosed in December 2017 with a rare neurological voice disorder called adductor spasmodic dysphonia in which muscles that generate a person’s voice go into spasms.
That’s when he began researching other treatment options and learned of a surgery called, Selective Laryngeal Adductor Denervation-Reinnervation (SLAD).
Flanagan said the surgery involves cutting the recurrent nerve on both sides of the throat. The nerve controls the ability to speak and part of a person’s swallowing. The nerve is severed. After that, another nerve in the neck is attached to the vocal cord. He would have one new nerve attached to his left vocal cord and another new nerve to his right.
“At that point, it’s not for sure that the nerve will regenerate,” he said.
But Flanagan wanted the surgery.
“They have an 80 percent success rate with this surgery, and as soon as I found out about this surgery I was 90 to 100 percent ready to have it done,” he said.
Flanagan also noted that doctors want patients to opt for Botox injections before surgery, because of the risk involved in the latter.
But by September 2018, Flanagan believed Botox was no longer an option for him.
“I couldn’t afford any more Botox treatments, so it was either quit doing Botox and be stuck with the choppy voice that had no volume—or do the surgery,” he said.
Flanagan discussed the situation with Bingcang. He sent Flanagan’s records to Dr. Joel Blumin, who specializes in laryngology and otolaryngology in Milwaukee. Flanagan said he asked for the soonest date available for surgery when Blumin told him he’d be a good candidate for it.
He had the 4 1/2-hour procedure on Oct. 18 at the Froedtert Hospital in Wisconsin.
When he awoke after surgery, his voice wasn’t loud, but it was smooth, not choppy.
“It was such a blessing,” he said.
Flanagan had a compression bandage around his neck and didn’t eat until the next morning.
He was released from the hospital at noon the day after the surgery.
Flanagan said he had no pain from the surgery itself, but had a sore throat from the breathing tube, which is common, and a migraine after the anesthesia. The migraine, he was, was his body’s reaction to the anesthesia.
Since then, it’s been a matter of recovery.
“Ideally, they tell you to take a three- to four-month leave of absence from work, because you don’t have much more than a whisper until that nerve regenerates and you get tired very easily if you have to speak much,” he said.
In most cases, a patient’s voice returns in three to four months.
“In my case, that didn’t happen,” Flanagan said. “I was at four months and I was still basically stuck with a whisper. My voice was smooth, but it was a whisper.”
So he would be back in speech therapy and taking another four months off work. He’s been doing speech therapy once or twice a week for the last four months.
“With two to three therapy sessions, my voice started coming back,” he said, adding that the brain must remap to the new nerves now hooked to the vocal cords.”
Speech therapy, he said, works with remapping the brain signal to the vocal cords.
Flanagan said his was a fairly rare surgery, but he’d have it again in a heartbeat. Flanagan said he faced the risks of being stuck with a whisper and swallowing difficulties, but was calm on the day of the procedure.
“I’d resolved this was what I was going to do,” he said. “The surgery either would work and I’d be where we are today or it wouldn’t work and I’d be stuck with a whisper, but at least I would have done something. Not doing anything didn’t make sense to me. I just knew it was right decision and it was the best option for me. The surgery has been very successful.”
Flanagan said doctors and his speech therapist think he’ll have 100 percent of his old voice back by next year.
“The hardest part for me is that I can no longer sing,” he said. “I knew that was most likely the possibility going into surgery, but it wasn’t until the last month or so that it finally hit me.”
Even so, he’s going to work with his speech pathologist during the next year to see if he can regain at least some of his singing ability.
Flanagan said communicating is much more important to him singing, since he teaches classes. He and his doctors believe he has about 70 percent of his old voice now.
He anticipates returning to work at Country Traditions on May 1.
“Work has been great about it,” he said. “I think they’re very excited for me to come back. They’ve been very supportive.”
Being able to hear a voice that sounds more like him has been a big mental boost and he’s enjoyed the reactions of others.
“I can’t even describe how wonderful it is,” he said. “The look on people’s faces the last couple of months is just priceless, because their joy is as much as mine.”