Helping patients save voices
Finally, in 2002, Ward, now 62, an expert in family enterprises, saved his voice by becoming a guinea pig. Traveling to Massachusetts General Hospital in Boston, he became the first patient to undergo a specialized laser treatment that cuts off blood supply, a process known as angiolysis, to the tumor without removing the cancer.Dr. Steven Zeitels, a pioneering otolaryngologist, or head-and-neck surgeon, performed the surgery. He will present his results on successfully treating about two dozen patients at the American Broncho-Esophagological Association annual meeting in Orlando in May.Depended on his voiceWard had been struggling, because his voice is his meal ticket. “There were times when I actually taught without talking, using a board and body language and hand signals,” he recalled.He saw doctor after doctor. He underwent speech therapy and used misters to lubricate his vocal folds, all to no avail.Based on research on the Web and at the urging of another Kellogg professor, Barry Merkin, whom Zeitels had successfully treated for a paralyzed vocal cord, Ward made the trek to see Zeitels, director of the Center for Laryngeal Surgery and Voice Rehabilitation at Massachusetts General.Zeitels found that Ward had a separate, invasive early cancer on each vocal cord, one tumor larger than the other. Ward said the cancer finding was a shocker because he had never smoked.Zeitels proposed a radical new approach: using one type of laser to cut off the blood supply to the smaller tumor, while physically cutting out the larger tumor with a conventional carbon dioxide laser.At Zeitels’ urging, Ward sought second opinions: “The surgeons would say their treatment was about 90 percent effective. The radiologists would say theirs was 90 percent effective but could never be used again. None of them recommended this novel laser approach. I decided to make a kind of faith bet, a faith-in-the-doctor decision.”Zeitels said the yellow- and green-light lasers he has used for the surgery are not new: “Yellow and green light are absorbed by the [oxygen-carrying] hemoglobin. To treat port-wine vascular abnormalities in children’s skin, Rox Anderson (director of Massachusetts General’s Wellman Center for Photomedicine) came up with the idea that if you pulsed light for a short period of time at the wavelengths that the blood would absorb it, the tissue around the vessel could cool so that you wouldn’t scar the baby’s skin,” he said.Zeitels said properly functioning vocal folds are soft and pliable like baby skin. He moved the laser into his specialty, initially treating non-cancerous conditions, such as precancerous dysplasia, papilloma, broken blood vessels, and polyps. Most famously, in 2006, he used the laser to save the vocal cords and career of Rock and Roll Hall of Fame star Steven Tyler. Tyler, known as “The Screamin’ Demon,” had experienced bleeding in his overworked vocal cords and had to cancel a tour.Ward’s cancer represented an unexplored territory with unknown risks. “I wasn’t worried. But I was certainly aware that we were doing an experimental, exploratory and unusual procedure,” he said. Generally, conventional radiation does more damage to the voice because the radiation is applied to both normal and cancerous vocal tissue, and the radiation can unnecessarily scar both. Two different types of lasers were used in two operations on Ward, a conventional carbon dioxide cutting laser as well as a yellow-light angiolytic laser with an affinity to hemoglobin. Over the years, researchers have found that the “green laser,” or pulsed potassium-titanyl-phosphate (KTP) laser, was more effective and easier to work with than the yellow laser.Precision work”Dr. Zeitels did such an incredible job of taking so little extra tissue that the vocal cord which was cut has recovered tremendously well. It does a lot of what it should do even though it was cut and you wouldn’t expect it to become as pliable as it eventually became,” Ward said. “On the other side, where he zapped the blood supply to the tumor, the cancer just naturally went away.”After a couple of weeks of voice rest, Ward found that his voice had returned to normal.Now, the professor said, “I can speak for six straight hours. I don’t use microphones any more than anybody else does. I just use microphones depending on the size of the room, rather than my situation. I just take it totally for granted now.”Dr. Lee Akst, a surgeon at Loyola University Medical Center in Maywood and one of Zeitels’ students, said he has used the KTP laser to successfully treat precancerous dysplasia. He added that he expects to study the laser’s use for invasive cancers.Showing gratitude Zeitels is optimistic that his study may help spread the technology, though the $65,000 per laser is a barrier in cost-cutting times. Ward and Merkin, grateful to Zeitels for saving their voices, started the non-profit Institute for Laryngology and Voice Restoration to promote voice research. They have raised more than $7 million and attracted singer Julie Andrews to be the honorary chairwoman. (Andrews has had her voice partially restored through surgery by Zeitels, but she awaits some biomaterial that Zeitels’ team is working on to replace her lost tissue; she is not a candidate for laser treatments.)Merkin, who said he was literally speechless for a year before being treated by Zeitels, said, “Losing your voice is an incredibly emotional experience. I no longer wanted to go to meetings. Dr. Zeitels restored my voice. Because he helps people in this way, he has become a godlike figure for hundreds of people he has treated. Our organization is made up of a group of passionate, grateful people who want to help others with the same problem.”
Tags: medicine, ngo, risk, shock