Sunday in Lima, laryngology conference

Sunday
I am in Lima, Peru again…but this time, I am on a laryngology mission.  I’m the SLP on the team, consisting of Dr. Craig Zalvan (of Phelps Hospital and, as of this semester, an adjunct faculty member of Mercy College’s program in Communication Disorders), Dr. Craig Berzofsky (yes, two Craigs, double trouble), Aaron Forbes, nurse anesthetist, Dr. Pat Chery, anesthesiologist and Lima native and OR nurse Marcella Steger.
Somehow, when you fly to Lima and home again, it is red eye both ways.  So, we arrived quite bleary-eyed on Sunday to Hotel Runcu in Miraflores.  I was able to have lunch with Maria Teresa from Kusi Rostros, one of our partners in caring for kids with clefts…more about her later in the week, but can you imagine that I spoke Spanish for 2.5 hours on topics ranging from family life to surgery to surfing! It’s a good thing MT has patience.
We had a great dinner, with pisco sours of course, and went to bed early.  Tomorrow is a  big day.
Monday
We were in our taxis by 7:30 am, off to Hospital Rebagliati, a giant white and blue edifice.  I don’t know how long it would take to figure out how to get around in this place…a resident confided that after two years, she still gets turned around.  Dr. Centennial met us at the gates.  It was wonderful to finally put a face to the name.  He has been working behind the scenes with CZ, Luis Montalvan and our medical student friend, Lily, for about a year to pull this conference off.
We jumped right in, seeing an assortment of people with lesions in the larynx.  The larynx, or voice box, is actually quite a small piece of anatomy, but it is where the vocal folds live.  These two little shelves of tissue, looking like pearly, grey bands in health, can be affected by many different insults and injuries.  Think about how much your voice is who you are…when you are hoarse for a few days with a cold or a sore throat, think how jarring it is to hear yourself.  In those cases, it’s pretty funny, because it passes in a few days.  The patients we were seeing have vocal pathologies of longstanding duration, one in particular for 8 years.  So the goal of improving the voice through surgery is a lofty one.  However, the larynx is just a valve at the top of your lungs, and a narrow place at that.  (Think of a whoopee cushion.)  So while we value the voice and work hard to restore it through medicine, surgery and therapy, keeping the airway open is the primary concern.  Some lesions we saw were in danger of keeping the patient from breathing.  When breathing and speaking are in competition, breathing must be giving priority; however, the microsurgical techniques being taught this week can often give a good result for both.
In the clinic, the young ENT residents ably passed the fiberoptic endoscope through the patients’ noses, and around the bend to see down the throat (We have this equipment at Mercy College, too.)  Dr. Zalvan, always teaching, gave some pop quizzes to the residents as we went. Without revealing too much personal information about the patients, we saw some cysts (like a ball under the thin mucosal layer of the vocal fold), some vocal fold paralysis, some old scars from previous injuries, and papillomatosis.  Papilloma are wart-like growths that grow anywhere in the throat and spread…and spread, and spread and spread.  They are caused by an HPV virus, similar to genital warts.  Almost all of us are exposed to these HPV viruses over time, but not everyone gets the warts.  It’s not clear why some people fight it off and some people get lesions.  We saw many cases of papillomatosis, one so severe that breathing was compromised.  That patient may end up with a breathing tube in the neck before too long.  The vaccine Guardasil protects against these strains of HPV. Dr. Zalvan predicts that if we get youngsters vaccinated, we will be done with this disease in 25-30 years. Because the papilloma spread and recur, patients have many surgeries and often end up with scarred vocal folds. Laser surgery, as is being taught this week, is much more sparing of the vocal fold itself, while effectively removing the lesions.
We saw many patients and started to put together a schedule for surgery on Wednesday and Thursday.  After yet another wonderful meal, and a quick drink at our hotel rooftop bar, we headed to bed…or to the casino.  It was bed for me.  Tomorrow is a big day. 
Tuesday
Tuesday was the beginning of our conference, an all day program of talks and roundtables.  As with many of our Peruvian adventures, we hoped for the best, planned for the worst and rolled with the punches.  Well, we were all pleasantly surprised when 90 people showed up to attend!  Advanced registration was very low but everyone just showed up and paid at the door.  So far, so good!  We also had a simultaneous translation system, where everyone had headsets and the translators sat in a broadcast booth.  As we spoke in English, it was immediately translated into Spanish, and vice versa.  Just pop the headphones on and off as need be.  It was just like the UN!  Did I ever tell you I wanted to be a translator at the UN when I was a child?  So, we were able to present in English and it was impeccably translated with no time delay. Perfect!  The roundtables were thought provoking, with interesting questions and the conference talks, by our team and by local physicians and SLPs, were amazing–educational, well-paced and on varied topics.  I cannot express how great the day went, in no small part to the hard work of Dr. Centero, Dr. Luis Montalvan and of course Dr. Craig Zalvan. I was able to connect with some local SLPs who have an interest in voice. Who can say what great collaboration that will lead to in the future?
With ENT, head and neck, med students, residents, nurses, anesthesiologists, SLPs and perhaps a few others, this conference was interprofessional education at its finest. Tomorrow we will all be in surgery together, embarking on more adventures.
Wednesday 
Today the conference continues with surgery.  We will have one operating room, with a closed circuit TV link to a conference room down the hall.  There will be two way communication as well, and the surgeons will be able to spend time between cases with the attendees.
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About Shari Salzhauer Berkowitz

Shari is a speech language pathologist and assistant professor of communication disorders at Mercy College in Dobbs Ferry, NY.
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