“The best way to evaluate hoarseness is to both listen carefully to a patient’s voice and to directly examine the structure and function of the larynx, an organ whose health is vital to good voice,” Dr. Friedman said. “We routinely use state-of-the-art digital videostroboscopy to specifically examine the vocal cords, which vibrate faster than almost any other part of the body – often 100-200 times per second during speech.”
“The appointment was pretty fascinating to me,” Carl recalled. “Dr. Friedman would play back the video showing the scope so that I knew exactly what he was looking at and what we were talking about.”
Carl’s fascination quickly took a turn after Dr. Friedman found that one of his two vocal cords was covered with a malignancy, or cancerous growth.
Wasting no time, Dr. Friedman discussed possible next steps with Carl. The two main treatment options were radiation or surgery – radiation being the more common treatment.
“My brother-in-law had throat cancer, and I remember him going through a lot of struggles with radiation,” said Carl. His brother experienced a lost sense of taste, dry throat and mouth and other unpleasant symptoms that can be associated with radiation within the throat. “All I could think was, ‘Man, I don’t want any of that.’”
Carl expressed his concerns to Dr. Friedman and wanted to avoid radiation all together if he could. Dr. Friedman agreed that the best approach would be surgery so that he could remove the disease, as well as attempt to restore Carl’s speech and voice back to normal.
When Carl was diagnosed with vocal cord cancer, memories of his father’s cancer diagnosis came back. He remembered that his father called all of his kids and grandkids to tell them what was going on.
“So that’s what I did,” Carl said. He called his kids and was very upfront about the news he was just given. To no surprise, his family was incredibly supportive.
Aside from love and support from his family, Carl also found hope in his own faith. “I spent a lot of time thinking about my faith,” he said. “All the time I have now is a gift.”
In January 2020, Carl scheduled his surgery with Dr. Friedman, who has over 10 years of experience treating patients with vocal cord cancer.
“Surgery has the advantage of being more precise in treating vocal cord cancer than radiation, which is especially important when only one vocal cord is diseased and the remaining other vocal cord is normal, as it was in Carl’s case,” Dr. Friedman explained. “Achieving the best voice outcome is about safely preserving as much normal vocal cord tissue as possible.”
For Carl’s surgery, Dr. Friedman used the KTP laser, one of the recent advancements in treating vocal cord cancer, which works by selectively targeting the blood supply that cancers need to grow.
Dr. Friedman trained first hand with the laryngologist who introduced this technology for treating early stage vocal cord cancer.
Even today, the KTP laser technique is not widely used among general ENT specialists or even many laryngologists due to the extensive learning curve to using the technology.
“We use the laser to remove the cancer with ultra-narrow margins, so that the healthy surrounding vocal cord vibratory tissue can be maximally preserved, giving a patient the best chance of saving or many times, even improving their voice in the process,” Dr. Friedman said.
“I didn’t know anything about the laser technique that Dr. Friedman was going to do, but I reminded myself that I was avoiding the possible devastation of radiation, so this was my only hope,” Carl explained.
Dr. Friedman found the malignancy to be deeper and more widespread than the scope at his initial appointment was able to show, extending the length of the procedure.
Carl’s wife and kids anxiously waited at the hospital. Finally, Dr. Friedman came out and put his family at ease. Carl began his two-day recovery at UC Medical Center.
“We were conservative in admitting Carl for a few days of observation due to the slightly deeper nature of his cancer,” Dr. Friedman explained.
Throughout his time at the hospital, Carl knew he was in good hands with his care team.
“Dr. Friedman is a good human being and a good doctor. In addition to his expertise, he has great bedside manners – his whole team does,” he said.
Despite a successful surgery, there was still more work to be done.
At Carl’s first follow-up appointment post-surgery, Dr. Friedman used a scope to see how he was healing and to establish a baseline to track his progress.
“Again, the whole time, Dr. Friedman told me what he was doing, why he was doing it and explained the approach he was taking,” Carl said. The epicenter of the cancer was healing well, but during office follow-up exams, Dr. Friedman found that there were white cells at one location in the periphery that looked concerning.
“Dr. Friedman told me that this area looked potentially pre-cancerous and that it would be best to do a secondary [outpatient] surgery to biopsy and treat the cells,” Carl continued.
Carl’s second surgery took place in July 2020 in the midst of the COVID-19 pandemic. Despite the pandemic, Carl had no worries about going to UC Medical Center. “I felt perfectly at ease with the steps that every employee was taking at the hospital,” he said.