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Old 01-07-2010, 09:30 PM
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LovingRadiance LovingRadiance is offline
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Default Neck issue question (off topic-but you all have good advice)

Hey everyone.
As you know I recently had surgery. It's formally called "Anterior Cervical Discectomy With Fusion" or ACDF.
One of the issues to deal with in the aftermath is a strangulation sensation.

Just to clarify-it does NOT impact my ability to breathe (at least so far). It does make swallowing (even saliva) uncomfortable which impacts what I eat somewhat, but not to the point that it inhibits my ability to have a healthy diet.

Unfortunately for me I have an unresolved lifelong terror (paranoia) of being unable to breathe. Most often in life this has come up when I'm in/near water or if someone ACTUALLY puts their hands on my throat. But I also don't ever wear turtlenecks or choker style jewelry.

Because of this I have been waking up repeatedly at night in the midst of full fledged panic attacks. I've managed to keep the panic at bay most of the time during the day (only 3 panic attacks during the day). I do spend much ofmy day consciously reminding myself that yes I can breathe and no I don't need to freak out-which is a ridiculous waste of time though.

In an attempt to give myself some reassurance that this is temporary I called the receptionist at my doctors office who had the surgery 11 months ago. That backfired though-because she continues to be plagued by this.

I went online to research it (which I suck at) and came up with some (minimal) information about it. I found that 1/250 people who have this surgery never do get relief from this sensation (here's to hoping I'm not #250).

I found a few other terms that SEEM to describe what's going on to some degree (but I'm not positive) which are
Dysphagia and Dysphonia and recurrent laryngeal nerve palsy.The Dysphonia isn't an issue-it pertains to your voice and my voice is fine. The one that seems most logical from what I could find is the last one,
recurrent laryngeal nerve issues.

But I can't seem to find ANYTHING that really addresses ways to... reduce the sensation or .. heck if I know how to put it...

Anyway-if ANY of you have any ideas on this-I could sure use some advice.

I also spoke with my father-who works in the medical field, he suggested the following:

Another thing you might not know about surgery is that
when they put the endotracheal tube in they sometimes have to press
fairly hard on the adam's apple to get the trachea lined up right for
the tube to go in. That's entirely possible as the cause of the
ongoing discomfort and should go away SLOWLY on it's own. Basically,
if you have to push hard enough on the adam's apple to mildly distort
it's shape for that it will take some time before it quits feeling the
"memory" of the pressure. The fact that it feels like someone has
their hands around your throat is VERY strongly indicative of exactly
that.



Ok. Not sure there is anything more I can say without droning on endlessly with no purpose except thank you for ANY suggestions. I really do appreciate all of you for being so positive, friendly and helpful these last couple months!
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Old 01-08-2010, 02:29 AM
GroundedSpirit GroundedSpirit is offline
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Hi LR,

Wow - that's a lot to endure. Our thoughts go out to you !
Can't offer a lot of medical advice here but can try to help maybe a tiny bit with the psychological issues.
I've had a only two major illnesses/injuries in my lifetime and one thing I noticed is that it's a bit of a battle to overcome phantom symptoms for a long while after the injury is technically healed.
I can only say - and with full realization that action is much harder than theory - that we DO have tremendous control over our brain function. But it takes a lot of work and you absolutely MUST believe in that capability 1000 % ! A common example most people have seen is fire walking. There's lots more. But you have to BELIEVE that it's YOUR brain and that YOU are in control - not "it". Which is largely scientifically proven so it's not hard to believe. But it's not what we were taught initially in science class.
I had my neck broken in 3 places this spring and still suffer some discomfort - a part of which I know is phantom. I also have nerve damage and have just been patient waiting to see if it will regenerate. Med science claims that nerves regenerate much slower than other tissue and to not be concerned for at least a year. Before much longer my patience will be exhausted and then I'm going to pursue a more complete confrontation with my brain to retrain it to accept the new condition as healed & normal.
In your case it seems the most worthwhile effort would be to address the underlying phobia you spoke of as your injury/surgery unfortunately ties into the same fear. Maybe someone with the proper background could make some suggestions on how to overcome that particular phobia.
Maybe try intentionally restricting your breath (by holding it). The more your brain realizes that temporary lack of oxygen is not the signal to go into 5 alarm mode immediately the better it will respond. This is pretty common in people with panic disorder as one of the primary symptoms of a panic attack is hyperventilation reducing oxygen. It's a chicken/egg problem and one of the first things you are usually trained to do to fight panic attacks is deep breathing exercises. I'm sure someone has already gone that route with you.

Good luck - stay positive and take control !

GS
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Old 01-08-2010, 03:19 AM
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LovingRadiance LovingRadiance is offline
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Thanks GS.
I am working on the mental part of it. I do pretty well most days holding it at bay by simply reminding myself that it's not REALLY inhibiting my breathing and/or over-focusing on some other activity.

Ironically-I can hold my breath and that doesn't bug me at all.

I believe it started when I was 3 or so. I don't recall the incident at all, but my family was hanging out with all of the extended family (LOTS of people) at my grandmothers (in Missouri). Her property has a pond and the kids (myself included) were playing on a hill of dirt by the pond. We got "smart" (or dumb as the case could be made) and created a "slide".
In the sliding on it-it got closer and closer to the water itself. Lucky me-I was the "breaking point" and slid in.
The hill was by the deepest side of the (very muddy you can imagine and therefore murky) pond.

I didn't know how to swim.

Obviously as I'm here typing 30+years later, they did manage to find me under the water (my father and another woman). Unfortunately by that point I wasn't breathing. Fortunately my dad was a perimedic and knew how to-and did do mouth to mouth.
Again unfortunately it was MILES from the nearest town. Someone (not sure if it was my mom or some other adult) drove to meet the ambulance after someone called 911 while my dad worked on me.

All I know about the end result is-obviously I lived and there's no brain damage.

But from that point on my parents kept me away from water. In middle school I went with friends to a pool. Being a very well endowed young woman (DD at that point but only a size 3 jeans) I tended to attract boys attention. The pool was in a local highschool. One of the older boys that we didn't know pushed me into the deep end. A friend pulled me out (thankfully quickly enough I WAS still breathing and no complications).

That along with a near scare at church camp at age 13 or so and I was pretty much "cured" of any desire to be near water and the phobia was well entrenched and controlling my life. I wouldn't wash my face in the shower or dunk my head under in the bathtub. I flat refused to go NEAR a swimming pool and I (this one is positive) NEVER entered a boat without a secure life jacket. I also never went in "open water" unless I was with one of VERY FEW trusted friends who I was CONFIDENT wouldn't allow anyone else to TOUCH me. I would wade in water then, and only then.

When my daughter was 3 (I was 19) I put her in swim lessons-because I didn't want her to be like me in that area. It required I enter the swimming pool building and that was traumatic for me. But listening to the cries of terror from her (which was crazy in a way-because the kid LOVED to hold her breath under water in the bathtub and I always let her and promoted it even though it chilled me to the bone to see) made me feel guilty.

Trying for the "mature" solution. I asked one of the lifeguards-who was also a friend to give me swim lessons one on one. She agreed.

It was a long trek-about a year. But I learned to swim (if not attractively-it IS functional )
I actually learned that it was LESS distressing for me to dive UNDER the water, holding my breath-and swim for however long, then come up for a breath, and go back under
Then

trying to do something like the front crawl-which I still can only do if there isn't a "crowd" in the pool with me as it causes anxiety issues.

I can dive off the diving board (low preferably as my large chest makes any type of dive from the high dive painful) and swim to the other end (beneath the water) and rise as graceful as you please to the top.

I can sit under the water with my 9 year old on the bottom of the pool with my eyes open (and his) and slowly blow out air bubbles to see who can stay down longest.

But I don't handle people's hands or arms around my neck (except Maca's or GG's at specific times which is even odder actually) and I obviously DO NOT do this sensation well either.
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Old 01-08-2010, 06:21 AM
Ceoli Ceoli is offline
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Hey LR,

As a voice coach, I've worked with a couple of people who had neck surgery, though neither of them were dealing with spinal surgery. But they both had some ongoing spasms and voice trouble after their surgery that did resolve within a few months for one and within a few weeks for the other.

The muscles around the neck and throat are some of the most extreme examples of fine motor coordination. They are incredibly fine tuned and balanced with each other. Unfortunately that also means that they're fairly fragile. Just think of the huge effect that just some mild overuse can have on our voices. When one part of that group doesn't work for whatever reason, it usually means the others overcompensate as a response. But the muscles are so specialized that they cannot really handle anything other than what they were built for. So it only takes a little overcompensating for the muscles to start going a bit haywire. There could be a variety of reasons why one part has stopped working, but in your case it probably has to do with the trauma of surgery.

If I was seeing you in person, the next thing I'd ask you to do is draw a diagram of your neck and point to the areas where you feel that strangulation sensation. That might give me a better clue of what muscle groups are at play there. But the fact that your voice isn't affected is a VERY good sign.

That's the best I can offer without knowing more specifics. It might be helpful to see a voice therapist or otolaryngologist for that specific symptom.

Last edited by Ceoli; 01-08-2010 at 06:24 AM.
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Old 01-08-2010, 05:09 PM
GroundedSpirit GroundedSpirit is offline
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Hi LR,

Very interesting detailed reply ! Lot of good signs in there. The fact that you have done awesome at confronting and apparently conquering the basic fears around water, oxygen deprivation etc are a real testament to how strong & capable you are. How much control you have over that brain.
You're swimming, holding breath under water etc - all things that in theory from your first post would have been major fear triggers. You're past that !
So...........
Maybe..........
Are you maybe really faced here with control issues ? When you are sitting under water, swimming under etc - YOU are in control.
I wonder if maybe there's something in your past relating to oxygen deprivation or strangulation (outside your control) that's triggering the responses sometimes. The reaction to the surgery would fit this nicely. Muscle spasms etc are things that are largely out of your "control".
Hmmmmmmm
Our brains as you know do lock stuff away in an attempt to protect us but sometimes that's not the proper technique it should use because the blockage isn't complete. We all know of examples of that. Like in my recent example I have absolutely zero recall of my accident - seeing the other car coming at me, the impact etc. Zero. Yet I was fully aware - on my way to work etc and remember much prior to and after the actual moment.
Makes me wonder if there was some event in your past that you don't recall that may have left this "string" attached. You may have blocked out the actual moment but enough of the connection is left intact to serve as a warning device in case it was to happen again.
A psychiatrist would probably advocate digging deep in your subconscious to try to surface the actual event, but myself, I question the necessity of that (and the pain & expense). I wonder if the same result couldn't be obtained by just accepting that fact that something like that DID happen and processing it the same as you have about the water/drowning phobia. You seem to have that capability.
In theory you (and someone trustworthy) could replay some variety of choking (at least grabbing your neck) scenarios which resulted in no harm and "retrain" your brain accordingly. Similar to what you did with the water, swimming etc.

No "expert" but it seems for you it might be something to think on.

Good luck !

GS

Last edited by GroundedSpirit; 01-08-2010 at 05:11 PM.
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