Dysphonia, Dysphagia, and the Dys- Between

A Terrifying Observation

At the end of a flexible nasoendoscopy, a procedure in which a small camera was passed through my left nostril, the right one having proved less pliant, there were a few conclusions, though none of particular concern.

The procedure examined my throat and voice box for a simple reason: since I commenced four weeks of radiotherapy for prostate cancer in September 2024, I had lost my natural voice. It had been reduced to a hoarseness, carrying a semblance of weariness and tiredness that might suggest I was gravely ill.

In general, I am fine. The voice that comes and goes does not reflect that impression, and yet a consultant on another stream of the multidisciplinary team that handles my clinical issues and healthcare outcomes has been on my case since January 2025.

Questioning the Cause

While I had surmised that the change in my voice was a long-term side effect of the radiotherapy, she disputed this. Even if I, as a man, were kicked in the testicles, with the usual prospect of momentarily losing my voice, and I had indeed been through the equivalent by way of radiotherapy, the effect should not last as long as it has in my case.

I even dared to question how she, as a female, would know about this uniquely male anatomy.

Then, at my biannual consultation just over a week ago, the consultant took the initiative on the matters I had been reticent to pursue, and scheduled sessions with other specialists in the very fields she had been seeking answers in. My hospital visit yesterday was to see an ENT (Ear, Nose, and Throat) specialist, or should I say an otolaryngologist.

Into the Consulting Room

Before meeting the consultant, I filled in three pages of tick boxes, affirmatives or negatives, to provide a general overview of what needed assessing. I was then called into a consulting room to sit in an abridged version of a dentist's chair.

On what was my third hospital visit in eight days, I could be forgiven for feeling some trepidation, whilst remaining hopeful that nothing untoward would be found.

Understanding Dysphonia

The condition under review is called dysphonia, a medical term for any voice disorder that makes your voice sound hoarse, raspy, breathy, or strained. This is in addition to sexual dysfunction, an obvious side effect of the radiotherapy, and dysphagia, another condition that may have been exacerbated by radiotherapy but has existed for longer, for which I had an oesophagogastroduodenoscopy in May.

In layman's terms, my vocal cords were considered quite thin, not closing properly when I talk, and carrying a slight tremor. It was watching the video playback, while we discussed the prognosis, that left me a little terrified. The movement of my vocal cords looked like the wings of a bat about to take off from a perch. You mean that was happening inside me?

The Prognosis

A contributory factor to my snoring was that my palate is unusually low, though nothing was attributed to that condition beyond the raspiness in my voice, which is probably caused by acid reflux that does not occur all that often.

We agreed there was little else to do, unless I initiated a follow-up because my voice had noticeably worsened, or unless I wanted the filler injection known as vocal fold injection augmentation, not an endearing prospect from what I have read about it.

Exploring the Prefix Dys-

Meanwhile, the original consultant has already scheduled an appointment to discuss the results, and I am learning more about the prefix dys-, which might refer to any of the following kinds of situations.

Bad / Ill: working in a harmful or poor way.

• Dysfunction: impaired or unhealthy functioning (e.g. family dysfunction)
• Dyspepsia: bad digestion
• Dystopia: a bad or undesirable society
• Dysphoria: a state of unease or dissatisfaction

Difficult / Painful: causing trouble or hurt to do.

• Dyslexia: difficulty reading
• Dysphagia: difficulty swallowing
• Dyspnoea: difficulty breathing
• Dysmenorrhoea: painful menstruation

Abnormal / Impaired: moving away from the normal state or standard.

• Dysplasia: abnormal development of cells or tissue
• Dyskinesia: abnormal or impaired movement
• Dysarthria: impaired speech articulation
• Dysgraphia: impaired writing ability

A Gemini Notebook AI Podcast on this blog

Somebody I used to know

Is that really me?

Yesterday brought some issues into stark relief as I attended a men’s group where a recording of an interview done some months before I commenced radiotherapy had ended up in a short documentary for the organisation.

Hearing my voice amplified and played back to my hearing still feels strange, there is a disembodied otherworldliness about it that leaves me uncomfortable. Having taken some readings at the cathedral, I am getting used to it, and it will only get better.

However, with my voice as it is today, the person I saw and heard looked like I was watching somebody that I used to know. There are differences I am working hard to bring back to who I once knew.

Managing the limits

For instance, I would have a brisk walk to the men’s group from my home in twenty or so minutes, that I was not even contemplating yesterday, I hopped on a bus for the three stops and on my way back, I did the same.

There is an urge to do a lot more, but I soon realise it tires me out quite easily, the occasions for rest are more frequent, and it could be a battle to concentrate. Yet, I do apply myself quite diligently to the tasks I set out to do from cooking to revising for a test among other essential activities.

No breaks in transmission

Earlier in the day before the men’s group, I was out to take a Microsoft certification test. I put in a good week of work on the material and in the process, I learnt quite a bit.

By Monday, I had done enough to tackle the challenge. Distractions impacted my ability to do a last revision overnight and from then, I decided not to bother myself any further with last dibs.

I passed the test and gained a new certification. There are vestiges of that person that I used to know that are still active. The temporary loss of strength and timbre in my voice does not indicate a loss of expression. I can be as forceful as I have always been.

After playing back the documentary, I was invited onto a panel to share views and opinions. Akin is still there, there is no break in transmission.

Photons on the Prostate - VIII

Fatigue is the issue

If you have been following my blogs over the last few weeks, the reason I have not given an update is because of exhaustion, I have been maximising the periods when my energy levels are high on activities on a priority scale.

In terms of the fatigue brought on by my radical radiotherapy treatments, I have not been able to schedule when I would have the strength to do anything. I take the rest when they come and the insomnia that results simply sweeps in without me being able to control the situation.

It is now obvious that at certain times of the morning into the afternoon strength wanes, and then late at night into the early morning, I feel much better about doing things.

A voice that wanes

This week has been one of many meetings I have prepared for but I found my facility and ability wanting. It started with a call from my GP and from the get-go, it was obvious they had very little knowledge of radiotherapy-related fatigue. The smart money was to chat to the radiographers and the doctor at The Christie Hospital, they know what courses of radiotherapy do to the body and they addressed the side effects with understanding and allowances required.

The thought of attending a 90-minute meeting on Tuesday left me concerned about whether I would make it through the first 30 minutes. When you feel weak, using your voice first belies that weakness and speaking is almost as energy-sapping as normal vigorous exercise. Eventually, your expression begins to wane and fade, and noticeably so. The conference lasted just under 95 minutes, on cancer support care and services available to me.

However, on Wednesday, I had favourable scheduling to address some activities assigned to me first, I apologised for my low energy levels as the morning was full of meetings and the afternoon session was at the point that I was ready to throw in the towel. My determination was to see it through and so I began, my voice a raspy whispery tone, slow and laboured, I made my points and successfully shepherded half my intentions with the other attracting three apologies from an interventionist that should have done their due diligence earlier.

My performance did not go unnoticed when someone opined that I was unwell and struggling. Struggling, I was, unwell, I definitely was not, and while fatigue might feature on a wellness spectrum on the lower end of it, it should not be confused with infirmity and incapacity. I fight the battles I can and retire when I need to.

Walking to full exhaustion

With enough time in hand before my hospital appointments, I boarded buses to my appointments though, on Wednesday just as the rush hour began, we were caught up in such a traffic jam, that I knew I could not walk the remaining 2.9 kilometres to the hospital, but I had to disembark to see if I could walk past the bottleneck.

My strut was excited and brisk, but I also felt as if, at any moment, I could just crumble and collapse in my stride. I willed myself on with the thought, not today, we’ll make it. About a kilometre later, I was beyond the constriction and an apparently traffic-free way looked ahead. I was also approaching a bus stop, having skipped about 10 buses ahead of my original one, I boarded the next arrival and got to the hospital in time for my 15^th radiotherapy session.

That walk was the most exertion I have had since I began treatment 3 weeks ago, in the 15 minutes that I was lying on the linear accelerator gurney, I had a catnap. My journey back home on the bus had me dozing off a few times, any of the last three stops if I missed any, I would still be close to home.

It’s now 4 to go

Yesterday, the session required an early start, and the bus journey was quicker, but my usual suite was very busy. For the first time, I did not have to present my scheduling sheet for a new time to have five in hand. We agreed yesterday that if the full schedule of appointments had been provided from the onset, it would have been quite psychologically daunting for the patient.

Giving you the first five and then for each subsequent day one is added to pace you without creating a burdensome and overwhelming schedule. It might affect your ability to plan well ahead of time, but it is very manageable.

I was called into another suite, my sixth in sixteen sessions, one of the radiographers had a Nigerian heritage as she was unsure of what her state of origin was even as her surname which typically would be of a northern origin was from the Midwest. I did hear my name called in the correct intonation, but we make all sorts of assumptions about people that might not be valid.

With that done, we now have four to go, I like to look at this in percentage terms, we are 80% done and I am drinking lots of cranberry juice too.

Blog - Photons on the Prostate - VII

Blog - Men's things - XX 

Men's things - XX

Insist and be insistent

Some encounters with the medical establishment can be unbelievably sublime and others exhibit inertia and obduracy, you might find pulling teeth a greater pleasure to enjoy. Here I was trying to get a sick note that I was told was easily obtainable and assured would be ready on Monday only to meet with a bureaucratic reluctance to fulfil what clearly everyone concerned knows is needed.

As with these things, I insisted against their prevarication, eventually someone cottoned on the idea that I was here for new excuses or postponements, something had to be done and so they sought out a late shift doctor and somehow found a stache of ‘Statement of Fitness for Work’ forms to be annotated and initialled by the doctor.

Their first attempt was clumsy, signing me totally off activities and the hospital stamp was upside-down. My reaction brought a reconsideration, and they did it properly with the caveats I wanted. It was an easy enough job with the will and opportunity to do it, hardly an encumbrance, this is a hospital, for crying out loud.

Just that spike is all you need

As I was chatting to a doctor, I also felt I could ask about the last two blood tests conducted a fortnight before my first radiotherapy session, my glimpse of the blood form indicated both the Prostate-antigen specific (PSA) and testosterone levels. I could not find the results anywhere as they were not communicated to my GP.

My PSA had fallen to within normal levels and testosterone was reading levels on the low side of the normal range. There must have been some other indicators in earlier blood tests to suggest I did not need hormone therapy before radiotherapy as testosterone has never been in the cachet of tests I have done before.

If I had not unilaterally pursued the need to recalibrate readings from my blood tests in February towards remediation by intervention, we would never have been on this track to discover prostate cancer and it might have been seething and growing undercover, but for that spike in my PSA in March that forced an investigation.

Do the graft on your bloodwork

It is no doubt incumbent that anyone with a modicum of literacy must take immediate interest and seek to understand what the results of blood tests are whether they fall in the normal ranges for your demographic and where they do not, ask questions and be unrelenting until this is explained in the simplest of terms. Err towards interventionism than otherwise, cancer is not something you wait and see grow like a wild weed in your body.

Demand answers and seek a second or even third opinion, speak with experts and learn all you can to be sure you are getting the best treatment towards the most beneficial outcomes. If you must go private and have the means to do so, do not count the cost and end up paying a costlier price.

The goal is the best outcomes

It took 7 months to get from my first request for a blood test to where the prostate cancer is being effectively treated with radiotherapy. I will cover in more detail sometime in the future, why I opted for radical radiotherapy over a radical prostatectomy. It was about the post-treatment quality of life more than anything else.

If anything, and for about 15 years, I have learnt and understood that your biggest advocate for the best outcomes when engaging the medical community is you, your voice, your initiative, your instigation, and your relentlessness. You are the centre of your diagnostic, prognostic, and therapeutic options. Remember, it is always your body first before it is their Guinea pig, that premise is non-negotiable.

Men's Things Blogs

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Thought Picnic: Seeking my authentic voice

Seeking the right voice

There is a lot I give thought to, that churns constantly within from conflict through confusion and seeking confession. Not confession in the sense of admission, but in the cause of affirmation, a profession of belief in the understanding of who I am.

Then, I think back to the absence of voice in the many things I could have voiced as opposed to the few times I have spoken without accentuating the better views, painting myself in the most unfavourable light to find some sort of agreement in understanding the afflictions I have entertained.

What I see that I have talked myself down, talked myself out, talked myself done, and talked myself lost, when there is much talking to do to talk up, talk in, talk better, and talk positive. Where is my voice of prayer? I ask.

Imagining the impossible

I have given myself to hearing, hearing for encouragement and support for the faith that comes from hearing. I hear more than I read, I listen more to understand, I understand even to act, and act to succeed.

There is a vision that replays in me with the conviction of the possible. I am on a journey that I am receiving the strength to conceive of what is totally beyond me and yet is the mystery of faith.

Let me understand even more how to be impactfully the best I can ever be in the walk on earth, that is my prayer and where my voice needs to be, day and night, in the full assurance that what I have imagined is possible.

Thought Picnic: The career skill of knowing chances, choices and risks

From before

I will like to continue on the blog I started yesterday on the response of Atul Gawande to the question about why he left the politics of being a policy wonk in the White House to return to medical school and take up surgery.

Blog – Thought Picnic: Becoming less dependent on the fortunes of others

“I wanted to be less dependent on the fortunes of others in making my own career; I wanted to be able to develop and voice my own ideas. And then there was this desire to have some skill besides just being at the abstract level of policy and work at that level. So I returned to medical school instead of taking up the offer to work on welfare reform.”

He went on to say about surgery, “I loved the sense of skill. And it reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain.”

Of skill to do

“There was this desire to have some skill besides just being at the abstract level of policy and work at that level…” Here, it is apparent that Atul Gawande had to make some serious life-changing and career-defining decisions. Whilst he did not knock the idea of being involved in policy making, he realised he needed to have other skills such that when the need for policy derived from his being dependent on the fortunes of others dried up, he will still be fully able to chart his own course.

It is also quite revealing for him to suggest that policy work was quite abstract rather than practical, even though policy has a way of affecting people’s lives. Yet, it was clear that if he had stayed, he still had ample opportunity within that political setting to be involved in welfare reform.

“I loved the sense of skill…” Yet, in leaving policy work for medical school and specialising in surgery, he had found a new vocation and calling, a sense of skill that went well beyond the abstract.

The excitement in the sense of skill is captured in his applying his acquired policy knowledge to his growing medical skill that he found ways to conflate politics and surgery in the following response.

Of chance and risk

“It reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain…” In essence, no knowledge in all his fields of endeavour was lost, rather the whole body of knowledge had become uniquely his own experience.

This experience is what now allowed him to understand the similarities between good politicians and good surgeons, and one might even say any profession where ability, skill, expertise and experience matters.

For we all have to be willing to take chances where there choices are not as obvious or the course is uncertain. In that, there is risk, some calculable and in other cases quite unquantifiable that is becomes somewhat adventurous, because from another viewpoint, noting ventured is nothing gained.

Knowing the uncertainty of skill

Many of us may be risk-averse, but without understanding risk and exploring the possibilities beyond what we know for certain, we risk living unproductive, mundane and boring lives with sadly unpromising careers to boot.

In all this is the ultimate lesson of knowledge and wisdom, that is to know what you know and what your skills can achieve whilst being very cognisant of the limitations of your knowledge and beyond attempting to bluff your way past issues where you have no ideas, you are geared to learn, to research, to reach and to extend yourself to acquire new knowledge and chart new courses.

The awareness of the fact that our skills even when well-honed might be uncertain to dealing with particular situations that we might have to adapt or withdraw to reflect and relearn is one of the greatest gifts of self-development.

My experience

Having worked in the Information Technology industry for about 28 years, I am well aware of the limitations of my skills, however, more importantly is the fact that I do not always have the answers or solutions to problems or challenges to hand.

In many cases, the knowledge to tackle an issue has only come from being presented with a particular situation that requires a resolution and since not all situations are the same, the solutions will differ.

Yet, all this knowledge becomes part of the body of knowledge uniquely mine that is a subset of my wider experience beyond just my profession and when presented with a similar set of circumstances again, I will probably be better equipped to provide a resolution much quicker than when I first encountered that setting.

I have never feared not knowing, nor have I been held back by not knowing what to do, rather, I have seen such challenges as new opportunities to broaden my knowledge and then return to resolve that conundrum, and doing the next thing. There is excitement is not remaining stagnant, but in pressing on and moving on.

These responses laid the ground for the beginning of the lecture on the subject – Why Do Doctors Fail? [PDF Transcript]

I hope to cover that lecture in some detail in another blog.

Thought Picnic: Becoming less dependent on the fortunes of others

An introduction

This is a blog of many blogs I should have written many months ago when I was first inspired, but I have left it until recently as I dithered over the last week on how to start writing.

Dr Atul Gawande gave four lectures for the Reith Lectures in 2014 on The Future of Medicine, the enlightening and interesting things he touched upon about medical practice and personal experiences with medicine and patients made for repeated times of listening in again.

The first lecture was titled, Why Do Doctors Fail? [PDF Transcript], there is much to discuss in this lecture, but I will first concentrate on some answers he gave when he was introduced to the audience.

I will eventually cover the topical issues in further blogs, every doctor and in fact, patients or prospective patients should take the time to read or listen to these lectures.

Some background

Atul Gawande is a typical third-culture-kid, born to Indian medical practitioners in the United States, studied at Stanford University, and was a Rhodes Scholar at the University of Oxford before taking medical degrees at Harvard.

However, before going to Harvard, he was a policy wonk on healthcare for Bill Clinton and was in the White House to help Hillary Clinton on her ill-fated Clinton Health Care Task Force. Being in the deep corridors of power, he could have chosen to stay there among the movers and shakers of America, but he did not.

Sue Lawley, the moderator of the first lecture at the John F. Kennedy Presidential Library and Museum in Boston, having surmised that he had worked for Clinton and gone to Washington, asked why surgery eventually won over politics.

Career independence

Atul Gawande answering many questions in the discussion before the lecture began showed a great sense of self-awareness and purpose.

“I wanted to be less dependent on the fortunes of others in making my own career; I wanted to be able to develop and voice my own ideas. And then there was this desire to have some skill besides just being at the abstract level of policy and work at that level. So I returned to medical school instead of taking up the offer to work on welfare reform.”

About surgery, he said, “I loved the sense of skill. And it reminded me of politics in some way – that the really good surgeons had to be like really good politicians in being willing to take chances, deal with risk, know that your knowledge and your skills are uncertain.”

Daring to chart an uncertain course

“I wanted to be less dependent on the fortunes of others in making my own career …” This profound sense of independence is incumbent on people at the beginning of their careers to comprehend. You need to understand and appreciate where your career is going, how it develops and who it might depend on.

Many for their skills and ability find themselves in positions of privilege and opportunity that they somewhat forget that situations and circumstances might be ephemeral or transient, they get comfortable.

I remember a younger friend who at 29 was about to be made a partner in a global consulting firm, probably the ambition of a majority, it represents the pinnacle of achievement for some, a fulfilment reckoning of accomplishment and achievement. My friend thought at that age, that becoming a partner with its opportunities would create a limiting perspective on his broader career, so he left the firm and embarked on an exciting middle-management career at other global firms.

With politics, nothing is certain either

With politics, there is even less certainty, your position is at the pleasure of the chief or patron, and you can be dismissed on a whim. When your principal ends their tenure you will likely be out of work too. Recognising this tenuous relationship can be the saviour towards a more fulfilling career.

In my own career, I have rarely been an organisation man, in all the years I have had any kind of employment, I have only been a full-time employee for 7 years spread over 4 different jobs in Nigeria, the UK and the Netherlands since 1988.

I began my foray into self-employment and consultancy in Nigeria after a year of being fully employed and wading into the uncertainty of the market but assured by the certainty of my skills and knowledge that I could not only dictate my terms but also reap huge rewards for choosing to be different.

This has served me well since July 1995 when I first went contracting in the UK, but for a 2-year stint of full employment in the Netherlands and when I had cancer through treatment and recuperation.

My fortunes have mainly been borne of my knowledge and instinct, skills I have acquired through self-motivation and ambition that have taken me into blue-chip companies around Europe proffering ideas and solutions to their challenges, both little and large.

To voice my own ideas

“I wanted to be able to develop and voice my own ideas.” There is every pleasure in having a mentor, in life and in your career, I have had quite a few and I cherish them. Most especially, I had John Coll who passed away last year. I was never his employee as I did not have the skills he needed in his organisation, he was always there to provide guidance, encouragement, advice and the steeling up I needed whenever my confidence was lacking.

More particularly, even when he first helped me redraft my resume in mid-1994 he was quite particular that it was written in my voice and my kind of thinking since I will be the one to defend it when at interview. I was offered a new job on that new marketing literature within weeks of publishing it.

Develop yourself as you

There are uses of patronage and the peddling of influence, but one must maintain a sense of independence of thought and voice with the ability to fearlessly convey those views. I can say that in my career, either as a contractor or a full-time employee, I have always been a good communicator of my views, some will say I am quite strong-willed, maybe I am.

Rather than being obsequious to your principal, I am of the view that if your views are forthright, sensible, reasonable, honest and clear, you will be of great benefit to all that you engage with, earning the respect of those around you even if you are disliked for your autonomy.

There is no pleasure in being a clone or a parrot, a poor imitation of the real thing schooled in the required talking points and jargon, acting to a set script in robotic obeisance and necessity, all in the quest to be appreciated and to belong.

It is so false, boring and quite unedifying in the long run. You eventually lose who you are and become a non-descript personality only differentiated by appearance and nothing else.

There is much else to mine in those quoted responses, but let’s start with this.

Extricate yourself from following others so close that you can’t cut loose when you need to, that you go down with them, if and when they do.