High-intensity exercise, Measles, Teeth whitening, Voice-lift

As High Intensity Exercise regimes hit the news headlines, Inside Health sceptic Dr Margaret McCartney reviews the evidence for short sharp workouts.

With new legislation restricting the use of teeth whitening products, Dr MArk Porter examines the science behind a brighter smile.

And misconceptions around so called 'Voice Lifts'. They are not designed to cosmetically rejuvenate the ageing voice, but to help people with real conditions that cause paralysis of the vocal chords.

Plus an update on the measles outbreak in Swansea.

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28 minutes

Last on

Wed 17 Apr 2013 15:30

Inside Health - Programme Transcript

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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT.  BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

 

 

INSIDE HEALTH

 

TX:  16.04.13  2100-2130

 

PRESENTER:  MARK PORTER

 

PRODUCER:  ERIKA WRIGHT

 

 

Porter

Coming up in today's programme:  Voice lifts - despite what you may have heard they are not the voice equivalent of a facelift designed to take years off the way you sound although the effects can be just as dramatic. I will be meeting the surgeon who helped this young woman go from sounding like this:

 

Clip:

Now here I was the following Monday morning with the waiting room not the hills alive with the sound of dogs snuffling and whining, cats meowing...

 

Porter

To finding her voice again:

 

Clip:

Someone to watch over me.

 

Porter

And from a healthy voice, to a bright smile - we review the latest evidence behind teeth whitening, and look at do-it-yourself kits?

 

But first, something else that is very much en vogue at the moment - high intensity exercise regimes. Although their popularity may have been dented somewhat this week after Andrew Marr blamed his stroke on over exertion in the gym.

 

Marr Clip

I had been very, very heavily overworking, mostly my own fault, in the year before that, I'd had two minor strokes it turned out in that year which I hadn't noticed and then I did a terrible thing of believing what I read in the newspapers because the newspapers were saying what we must all do is take very, very intensive exercise in short bursts and that's the way to health.  Well I went on to a rowing machine and gave it everything I had and had a very strange feeling afterwards and then a blinding headache and flashes of light, served out the family meal, went to bed, woke up the next morning lying on the floor unable to move.

 

Porter

Andrew Marr speaking on BBC1 at the weekend.

 

Inside Health's Margaret McCartney has been looking at the evidence behind high intensity workouts and joins me now from our studio in Glasgow. Margaret what is the theory behind these new regimes - and where have they come from?

 

McCartney

I think the bottom line is that people think that it will make you fitter quicker and with less time spent on it.  So I think that's the theory.  Studies that have been done that purport to show that this is going to be the new big thing have looked at very, very short intervals of high intensity exercise.  So there was a big study - well it was a small study but it had a big impact in the news media, it was published in 2009 and it just took 16 young healthy men over two weeks and gave them six sessions of sprinting on a cycle, 30 second bursts and their total exercise over the two weeks was 15 minutes.  They only burned about 250 calories a week and what the study authors were putting forward was that this was a very effective training regime to improve these young men's insulin action in their bodies and the idea from other studies as well is that this has improvement in your fitness beyond which you normally get from our normal recommendations to do moderate intensity exercise most days.

 

Porter

So you can see the attraction and it's hard work pedalling like mad for 30 seconds but only 15 minutes over two weeks, compared to a few hours in the conventional...

 

McCartney

Yeah, I mean I have to say I'm pretty sceptical about it overall.  Most of the studies that have been done, the larger size studies, have looked at interval training that's been one minute off, one minute on, that kind of thing and basically the time spent is around 20 minutes versus your 30 minutes, which is the one that's recommended already, so I really don't know if 10 minutes is that huge a difference to an individual person.  The other problem is that we know from - there was a big review that was done in journal come out from McMaster University last year which was a review article looking at the place for high intensity training in the grand scheme of things and basically said this does exist but it's extremely demanding, it may not be safe, it may not be tolerable and it may not be appealing for some people to be able to do it.  So they were basically saying there's some evidence here, it's very early evidence, and I think what really strikes me about it is that it's really at stage one this kind of evidence, it's been done in clinical trials under supervision, so people are being selected because generally they're fit, if people are being selected because they've already got illnesses or diseases that are going on and researchers want to know the impact it's been done in a clinical trial, so people are being well looked after because of it.  And what we don't have is the outcome data that says that this will prevent heart attacks, strokes, stop cancers, save lives in the same way as we know for our normal recommendations for exercise do already for us.

 

Porter

I suppose the worrying thing as a clinician is the idea perhaps middle aged, going to a gym and going for it, we can all understand why people like a quick fix, I mean does it worry you that people see this as a quick fix to correcting things that actually require a lot more investment?

 

McCartney

Yeah, I mean I think the history of medicine is littered with things that were sold to us as a quick fix and turned out to be nothing but.  And I'm afraid my scepticism would extend to the idea that we can somehow undo a lack of exercise every other day of the week by doing a couple of minutes a few times a week.  So I mean I am very sceptical about it and I'm also concerned about the potential harm for someone who has not exercised for a long time or is not very fit or who has risk factors for heart disease or for stroke and who decides to use this unlike the proven evidence based moderate intensity exercise - building up over a period of time - and there's lots of resources online, for example NHS Choices does a great couch to 5k app and program for someone that's really - really designed for people who haven't done exercise for a while to build it up safely and over a prolonged period of time.

 

Porter

Margaret McCartney thank you very much. 

 

Well one way to ensure you don't push too hard is to monitor your pulse rate while you're exercise using a pulse rate monitor - available from all good sport shops and many gyms.  Ideal training ranges vary but you should never let your pulse rise above 220 minus your age (so that's 180 beats per minute for a 40 year old, and 170 for a 50 year old).

 

From faddy exercise regimes, to faddy diets. Our item earlier in the month on two day diets - the ones where you fast or restrict carbohydrates for two days a week - prompted Will Wallace to e-mail us regarding our conclusion that they simply work like every other diet by reducing your calorie intake.

 

Wallace (read)

Obviously it is about consuming less calories - but it is the method of achieving that which is new. I have been on a two day diet since September and have managed to lose weight, and keep it off because I have enough willpower to restrict myself for two days, and enjoy guilt free eating for the remaining five.  It's the simplicity that makes this new approach so attractive.

 

Now back to measles.  The latest figures for the measles outbreak in Swansea have just been released and this time last week I was speaking to the director of the Communicable Disease Centre in Wales Dr Roland Salmon and he's back on the line for an update.

 

Dr Salmon, how many cases have you had now?

 

Salmon

Well we're currently at 765 notified cases in the outbreak area, which is the boroughs of Swansea, Neath, Port Talbot and Bridgend.

 

Porter

That's up about - that's up 145 since we last spoke.  Is there any evidence that this is spreading outside, beyond the Swansea area?

 

Salmon

Whilst there are occasional cases from other health boards in Wales and there are one or two other places in England where there's measles activity we're not seeing extensive spread outside the area we designate as the outbreak.  Levels of activity there are remaining, I'm pleased to say, reasonably low and reasonably similar.  Obviously we're watching the situation very closely there.

 

Porter

Who'd be a prophet in this game but do you think we're approaching the peak, have we seen the worst of this?

 

Salmon

I'd be disappointed if within the next two to four weeks we didn't turn the corner but as you say who would be a prophet in this game.

 

Porter

Dr Roland Salmon, thank you very much.

 

Please get in touch if there is a health issue that's confusing you - send a tweet to @bbcradio4 including the hashtag insidehealth or e-mail insidehealth@bbc.co.uk

 

New legislation to restrict the use of teeth whitening products was introduced last October.  The regulations now limit the strength of bleaching gels - to no more than the equivalent of 6% hydrogen peroxide for dental use, and just 0.1% for DIY kits - levels that are much lower than some dentists have used in the past, and way lower than are still found in some kits that can be bought online. And it is made all the more confusing by the fact that different products use different active ingredients, in different concentrations.  But at the end of the day, they are all bleaches. So how safe is it to put bleach on your teeth?

 

Nicholas Lewis is Consultant in Restorative Dentistry at the Eastman Dental Hospital in London.

 

Lewis

Yeah, teeth whitening, teeth bleaching are essentially synonymous terms.  Tooth whitening, I think, comes over as a better way to describe it but we are essentially bleaching the teeth, so you'd expect them to become whiter, brighter, lighter - whichever one of those we'll describe it as.

 

Porter

And we're bleaching what - is it just the outer layer of the enamel?

 

Lewis

The real answer to that is we don't exactly know the function and how it actually works.  What we do know and what we think happens is that some of the compounds within the tooth that discolour a tooth and alter the light reflecting properties of the tooth they are changed by that peroxide process, there is oxygen liberated and whether or not those compounds then leave the tooth or are changed into smaller compounds we don't exactly know.  But the general effect is that the tooth becomes lighter and brighter and to the patient a whiter appearance.

 

Porter

People like having a brighter smile, there's no doubt about that, but what about the effect - the long term effect on the teeth, I mean are they shortening the lifespan of their teeth?

 

Lewis

Absolutely not, I think we can go the other way actually.  I think we have to look at these teeth whitening procedures as a very ethical and conservative way to manage discoloured teeth when done appropriately and by the right appropriately qualified people.  Alternative ways to change the colour of teeth would be things like crowns and veneers, which require a proportion of the tooth to be removed, so actively taking away tooth structure and that undoubtedly weakens the tooth over the longer period.  So whitening essentially alters the colour of the teeth without affecting the structure and that's got to be a good thing.

 

Porter

I suppose my concern is that it's a relatively recent technique, are we going to be looking back on this in 20 or 30 years' time and saying whoops this has damaged the teeth in some way, can we be sure about that?

 

Lewis

I don't think we can be sure until there's the hard evidence, as with many things in medicine and dentistry, it's very difficult sometimes to get that evidence.  We've been using peroxide to change the colour of teeth within dentistry for well over a hundred years, not to the same extent and the same frequency that we're currently doing it but we've certainly been doing it on a fairly frequent basis since the late '80s when it really became a technique that came back into fashion.  So I don't think there's going to be adverse effects and there's no good evidence to support that with some of the longer term studies.

 

Porter

Who can actually do this, you say it's important to consult a professional, are we talking a dentist?

 

Lewis

We are absolutely now.  New legislation came in via way of a new EE directive back in - end of October 2012 which says that these now must be dentist supervised procedures, undertaken either by a dentist or by the direct supervision of a dentist.  So hopefully that will mean that these changes to the law mean that the unsupervised whitening of teeth by non-dental professionals will stop.

 

Porter

So you have to consult a dentist to have your teeth whitened professionally but people could still freely buy DIY products online.

 

Lewis

They can, potentially the people who are offering those products, if they're not dentists and it's not dentist supervised, would fall foul of the law.

 

Porter

Nicholas Lewis and I'm joined in the studio by Liz Ridley who is Managing Director of Pearly's Tooth Whitening Products who sell DIY kits, and Linda Greenwall who is a dentist and Chairperson of the British Dental Bleaching Society.

 

Linda what, in your opinion, is the safest and most effective way to whiten your smile?

 

Greenwall

Following a thorough assessment by the dentist to assess that it's appropriate and exclusion of diseases in the mouth the dentist would make some bleaching trace for the patient and they would use a lower strength hydrogen peroxide, which is called carbamide peroxide, which releases slowly, it's equivalent to 3% hydrogen peroxide.

 

Porter

Over what sort of period?

 

Greenwall

Over about two to three weeks, there's a specific protocol - upper only first, then [indistinct words]...

 

Porter

Liz, your product is used how?

 

Ridley

After a full assessment with a dentist to make sure that there are no problems we would recommend...

 

Porter

That's what you recommend, you can't provide - you recommend.

 

Ridley

We can't force the customer to do that, they sign a form saying that they've had a check-up recently but that's up to them if they tell the truth or not.  Then they would take their own impressions, following the instructions and the video that they can look up online, and they send those to our lab, along with our dentist customers who do the same thing, and then our lab makes up their trays, sends it back to the customer with their whitening gel which they can use.

 

Porter

What's the active ingredient?

 

Ridley

The active ingredient is sodium perborate and sodium bicarb.  Sodium perborate does break down to hydrogen peroxide but in the case of our products lower than the .1 cut off point.

 

Porter

Right, so the equivalent dose of hydrogen peroxide in your products would be - fits within the law, so your product, as far as you're concerned, is completely legal and completely safe?

 

Ridley

Yeah, yeah.

 

Porter

Linda?

 

Greenwall

So the current legislation says it should - first a dentist needs to consult, to see whether it's appropriate, because what they're looking at is patient safety...

 

Porter

Is that irrespective of the strength of the product?

 

Greenwall

Yes absolutely.  And they introduced the legislation to ensure that there was better patient safety, so they don't want patients buying products which may be inappropriate for them to use in...

 

Porter

Inappropriate in what way then, I mean what's the downside if you buy something that's inappropriate?

 

Greenwall

There could be misuse, overuse, or abuse of the product when they haven't been explained how to use it and not under direct supervision.  So, for example, if you had an abscess in your mouth and you used one of these products that could make the abscess flare up and so it could make things worse and result in quite severe pain.

 

Porter

So your argument is that whitening - you're for whitening but it needs to be in conjunction with basic good dental care and that involves a visit to a dentist?

 

Greenwall

That's right.  First of all it needs a proper assessment to see whether whitening is appropriate, it's not appropriate for everybody and that is why it needs to be looked at.

 

Porter

I'm sitting here playing devil's advocate.  Liz, you've got a vested interest in flogging as many kits as you can, I understand that, Linda you've got a vested interest in keeping this within the domain of the dentist because I presume this is quite a significant earner on the private side for a lot of dentists.  So convince me - if I buy one of Liz's kits realistically and I've got quite good dental hygiene and I don't have a lot of problems I'm unlikely to run into trouble aren't I?

 

Greenwall

Yes you could run into trouble.  You can damage the teeth by overuse of the product and this is what they were concerned about because there are numerous other products available over-the-counter and the European directive, the European Council of Dentists actually actively discourages patients from buying strips etc. over the internet because of that.

 

Ridley

Yeah we're talking about hydrogen peroxide there and I absolutely agree with you... it can be very dangerous.

 

Porter

I mean one of the problems, isn't it, Liz that actually I mean your product might be legal under the current legislation but there are lots of products out there for DIY, particularly available online, that do not conform to legislation - are you being tarred with the same brush?

 

Ridley

Absolutely we are in a very aggressive way actually and I've asked to meet with the CEO of the GDC lots of times...

 

Porter

General Dental Council.

 

Ridley

... absolutely, the General Dental Council, because I said we really need to get some proper guidance from you here.

 

Porter

Linda, having heard what Liz's product is, that it conforms to current legislation, I mean are you still opposed to her particular products or is the stronger ones that are being sold...

 

Greenwall

It's the whole philosophy of patients buying the product and then don't know the appropriate use.  Many patients think that once it's okay, maybe twice is better, maybe three times a day is absolutely fine and so there have been many reports about the dangers of the over-the-counter whitening products.  Where kids have used it - young kids, like 16, 17 have overused the product four times a day, misused it, caused damage and harm in all kinds of ways.

 

Porter

So your problem is with the DIY aspect of this, irrespective of whether the kit's legal or not.  Liz, I mean Linda makes an interesting point there, you watch any programme on television involving youngsters at the moment the celebrities have teeth the colour of my loo - I mean they're bright, bright, white - and that does encourage children to be using products like this, I mean you've got no idea who's using your products have you?

 

Ridley

Nobody's allowed to buy our products unless they're over 18.  Our customers take impressions of their teeth following our guidelines which strongly say they mustn't have any treatment until they've kept up to date with their dental check-ups.

 

Greenwall

It's inappropriate for patients to take impressions of their own teeth to make their own bleaching trays, that's totally inappropriate and we feel it's better for the dental profession to take their own...

 

Ridley

Why is that?

 

Greenwall

Because the trays - what happens is they're made too big, they cause rough edges on the gums, they damage the gums, inside them the mucus membranes are damaged, it's inappropriate.  And again the patient is self-diagnosing, why - they don't know why, there are many reasons why teeth discolour, many, many reasons and that needs a proper diagnosis.  Tooth decay is not going to go away with a home kit...

 

Ridley

Which is why we say everybody needs to have their teeth checked by their regular dentist first.

 

Greenwall

Yes but they don't always, there's an easy solution to do that and that's why the misuse is so easy to happen, it does say...

 

Ridley

You could say that about any medicine that you can buy over-the-counter.

 

Greenwall

The legislation is very clear now - dentists need to evaluate very clearly...

 

Ridley

The legislation is clear and we're within it.

 

Greenwall

Anytime somebody who is not a patient puts their hands near somebody else's mouth that is the practice of dentistry and so that is restricted to dentists and that's a general dental...

 

Ridley

Well that's - I mean I've got the Dentistry Act in front of me here, the 1984 Dentistry Act doesn't say that.

 

Greenwall

It's very, very clear under guidelines...

 

Ridley

Well shall we read it?

 

Porter

But do you think consumers are missing out - having to pay more money for the same thing by going to see a dentist?

 

Ridley

I think they need to have the option, I think customers are intelligent enough, I don't think we need to nanny them and they can choose whether they want to buy this off the counter after having seen their dentist or whether they want to get it off from their dentist.  We also make whitening trays for dentists - we have dental accounts who use our services and we make the trays for them so there's no reason to think that our trays are any - are going to cause any damage.

 

Porter

Linda, there is a sort of halfway house here, what happens if I come and see you and properly assessed - have trays made up and have all the stuff done - and I want to do it again two or three years later, because it doesn't last forever, can I then do a DIY kit?

 

Greenwall

No you can't.  The material that the dentists have have been carefully researched for many, many years, they also have to show safety, they have to show safety for the gums, the oral membranes, the whole area but they have to show that the whitening can last for six months minimum and most of these kits that the dentists use have been carefully researched to show they last much longer than six months, so patients don't need to constantly buy and purchase once they've undertaken the treatment properly - that can last for three or four or five years without keep whitening and that's what we don't want the patients to do - keep whitening - because it doesn't whiten effectively, the first time - so they're just constantly buying more and more product which is a good thing for the product manufacturer because they'll sell more gel.

 

Porter

Liz, in the longer term it may be cheaper to go to the dentist.

 

Ridley

I think it's very important to go to the dentist, I wouldn't argue about that, absolutely, I don't think it would be cheaper to go to the dentist and I don't think you can possibly say that it's going to last five, six years, necessarily, it depends on how porous your customers' teeth are, whether they smoke, whether they drink a lot of coffee.

 

Greenwall

Not really actually because there's very clear evidence to show how well it lasts and how effective it is.  Your customers are going to be safer if they go to the dentist to assess that first.

 

Porter

Well we'll put links to both your websites on ours so listeners can make up their own minds.   Liz Ridley and Linda Greewall thank you both very much.  And to find our website you go to bbc.co.uk/radio4 and click on I for Inside Health.

 

Now from bright smiles to clear voices and a procedure that has been labelled the voice lift. Consultant ENT surgeon Declan Costello works at Queen Elizabeth Hospital in Birmingham where he offers the procedure under local anaesthetic. But despite the conations, so-called voice lifts are not about helping middle aged radio presenters like me sound younger.

 

Costello

Well that's a misconception that's grown up largely I think because of the way the term has been used and applied to this.  The whole problem has arisen around the phrase - voice lift - in and of itself, it's not really a voice lift, it's a bringing together of the vocal cords, it's not an attempt to rejuvenate the voice, to turn a 70 year old voice into a 20 year old voice, it's to make a weak and breathy voice less weak and breathy and stronger and better able to communicate because they have particular conditions.

 

Porter

But the way it's been portrayed in the press here, particularly in the UK, is this voice lift image that it's a sort of cosmetic procedure a bit akin to facelift. 

 

Costello

Indeed, I mean I don't see it that way at all.  The patients who I'm treating with this particular technique are really patients who have a clear need for their voices to be altered.  So there are two situations principally in which the voice can become weak and breathy.  One is in which there is a paralysis of one or other vocal cord and the other is in which the voice is ageing.  Now that latter group - the older group - whose voice becomes weak and breathy is by far and away the less common of the two.  The vast majority of patients I'm treating with this procedure have a paralysis of one or other vocal cord.  In order to produce a normal clear voice it requires you to be able to bring the vocal cords together and as the vocal cords are brought together it cuts off the stream of air from the lungs.  If the vocal cords don't close fully there is an escape of air and the voice perceptually comes across as being breathy.  So if one or other vocal cord is paralysed you get this escape of air and breathiness and as a consequence the patient has a very tight and high pitched voice.  And paralysis of the vocal cord can happen in a variety of different situations, sometimes a vocal cord just stops working for no very obvious reasons.  Sometimes a vocal cord stops working as a result of an interruption of the nerve supply to the larynx and there are nerves on each side that control the movements of the vocal cords and if for whatever reason that nerve is damaged then it can stop the vocal cord from moving.  So, for example, if somebody has had a brain tumour - I have a patient called Steph who had a brain tumour operated on and in the course of removing that it was necessary to remove some nerves and that caused a paralysis of the vocal cord.

 

Still

I was diagnosed with a brain tumour in 2011, May, and I had to have an operation to have it removed and when I woke up I had like literally no voice, so it was like a whisper, just very quiet, literally like hello, it had no power behind it.

 

Porter

Could people hear you when you were talking?

 

Still

In a very quiet environment you could, like one to one, but going out for meals I couldn't order my food because no one could hear me over the hustle and bustle of every day.

 

Porter

Well your voice is quite important to you because...

 

Still

I'm a musical theatre college, I'm in my final year now doing musical theatre studies - singing, dancing and acting.

 

Porter

What did the doctors tell you had happened?

 

Still


They said probably because of where the tumour was, it was around the nerves that control your larynx and they had an endoscopy and they could see that my left vocal fold was paralysed but my right vocal fold was still working.

 

Porter

So the one side was working alright but the other one was floppy?

 

Still

Yeah, wasn't working, so the vocal folds weren't meeting to then produce a sound.

 

Porter

How did you feel when he offered - said I might be able to give you your voice back?

 

Still

I was like yes please. 

 

Costello

In this situation when the vocal cords aren't able to come together properly what you want to do is to encourage the vocal cords to close fully in the course of phonation, in the course of using the voice.  The easiest way to do that is to fill up the paralysed vocal cord, usually a paralysed vocal cord, with material, either a pre-prepared synthetic material or fat or a piece of plastic that you can put in from the outside but anything really to push the vocal cord across so that the working vocal cord can come across and meet it.  And I think what's new about these procedures over the last few years is the ability to inject the vocal cord under local anaesthetic in the clinic, it takes 20 minutes, half an hour or so to do, it's really very quick, the patient walks in, walks out and it's a very straightforward thing to do.

 

Porter

You say straightforward but you're operating on someone's vocal cords, they're also breathing through there, it sounds quite difficult.

 

Costello

Sure, it's technically a fiddle but when you have the correct equipment and the correct expertise and all the right people around it's an extremely satisfying thing to do.

 

Porter

The other image that this term voice lift conjures up is that of people going to have this done privately, is this something that's available on the National Health, are you seeing patients on the National Health?

 

Costello

Absolutely yes, I mean the procedure I'm doing, as I say, is almost entirely for patients with vocal cord paralysis and in that situation there is no issue whatsoever it's an entirely medical procedure for giving patients their voices back.  In the older patients as well, I mean I see it in a patient who's in their 70s or 80s and has difficulty communicating with their spouse I see that as an entirely reasonable thing to do to give them their voice back and so that they're able to communicate.  There are lots of surgeons in the country who are doing these injections under general anaesthetic using a variety of different materials, there are relatively few who are doing lots of injections under local anaesthetic, I guess maybe 10 or so around the country who are doing it.  I think there are very distinct advantages to doing it under local anaesthetic.  There are several of my patients who have had conditions where they're profoundly unwell, so for example they've got a lung tumour and they wouldn't be well enough to survive a general anaesthetic but they are well enough for me to inject something into their larynx under local anaesthetic.  And if they've got a large lung tumour maybe they only have a prognosis of a few weeks or months they might just want to be able to communicate with their family in Australia for those last few weeks or months of their lives and actually being able to do this for them under local anaesthetic, whereas previously we might not have been able to offer that, is very satisfying.

 

Porter

Is it a one off procedure?

 

Costello

It depends what you use.  In certain situations I will inject a temporary material into the vocal cord if I think that there is a chance someway down the line that the vocal cord is going to start moving again.  So if the patient has had, let's say, a thyroid operation, which is one of the more common reasons for a vocal cord to stop working because the nerve can be damaged in the course of a thyroid operation, if a patient's had a thyroid operation but the thyroid surgeon is very clear that the nerve was okay in the operation, we think that maybe the reason the vocal cord's not moving is just that the nerve was bruised, in that situation I anticipate that that vocal cord is going to start moving again at some stage in the next few weeks or months, so what I'll do is to inject a temporary material that will dissipate over the course of three or four months, I'll wait for the vocal cord to start moving again and if and when it does then the patient just goes on their way.  If the vocal cord doesn't start moving again then I can inject something more permanent.  So there's a range of different materials you can use to inject according to what the clinical situation is.

 

Porter

And are the effects immediate?

 

Costello

They are, yes, the patient within seconds that goes from having a very weak voice to actually being able to speak relatively normally, it takes a little bit of getting used to for the patient actually because you've changed the mechanics of how the voice is working quite radically and it can often take a few days for it to bed in.  And I will often advise patients not to use their voice for a few days after the procedure just to allow the material to spread within the vocal cord.

 

Still

It was definitely louder as soon as I woke up but it was very urrr...

 

Porter

Croaky.

 

Still

A little bit as it was sort of getting back together.  But then over the next say four or five months it just got stronger and stronger every day.

 

Porter

What about the singing?

 

Still

It was very hard to start off with as I was getting this voice back but my range has come back and I'd say I've got a slightly like sweeter tone.

 

Singing - Someone to Watch Over Me

 

Porter

Stephanie Still who has found her voice again thanks to surgeon Declan Costello - and you will some useful links on the procedure on our website. Go to bbc.co.uk/radio4 and head for the Inside Health page.

 

In the next programme I will be taking a closer look at tamoxifen - a common treatment for breast cancer - and a simple, but effective way of working out if your medicine is causing unwanted side effects - a drug holiday. Join me next week to find out more.

ENDS