Larynx Cancer (cont.)
Rehabilitation after surgery for larynx cancer
Living with a stoma
Learning to live with the changes brought about by cancer of the larynx is a
special challenge. The medical team will make every effort to help you return to
your normal routine as soon as possible.
If you have a stoma, you will need to learn how to care for it:
- Before leaving the hospital, you will learn to remove and clean the trach
tube, suction the trach, and care for the skin around the stoma.
- If the air is too dry, as it may be in heated buildings in the winter, the
tissues of the windpipe and lungs may produce extra mucus. Also, the skin around
the stoma may get sore. Keeping the skin around the stoma clean and using a
humidifier at home or at the office can lessen these problems.
- It is very dangerous for water to get into the windpipe and lungs through the
stoma. Wearing a special plastic stoma shield or holding a washcloth over the
stoma keeps water out when showering or shaving. Other types of stoma
covers-such as scarves, neckties, and specially made covers-help keep moisture
in and around the stoma. They help filter smoke and dust from the air before it
enters the stoma. They also catch any fluids that come out of the windpipe when
you cough or sneeze. Many people choose to wear something over their stoma even
after the area heals. Stoma covers can be attractive as well as useful.
- When shaving, men should keep in mind that the neck may be numb for several
months after surgery. To avoid nicks and cuts, it may be best to use an electric
shaver until the numbness goes away.
People with stomas work in almost every type of business and can do nearly
all of the things they did before. However, they cannot hold their breath, so
straining and heavy lifting may be difficult. Also, swimming and water skiing
are not possible without special instruction and equipment to keep water from
entering the stoma.
Some people may feel self-conscious about the way they look and speak. They
may be concerned about how other people feel about them. They may be concerned
about how their sexual relationships may be affected. Many people find that
talking about these concerns helps them. Counseling or support groups may also
be helpful.
Learning to speak again
Talking is part of nearly everything we do, so it's natural to be scared if
your voice box must be removed. Losing the ability to talk-even for a short
time-is hard. Patients and their families and friends need understanding and
support during this time.
Within a week or so after a partial laryngectomy, you will be able to talk in
the usual way. After a total laryngectomy, however, you must learn to speak in a
new way. A speech pathologist usually meets with you before surgery to explain
the methods that can be used. In many cases, speech lessons start before you
leave the hospital.
Until you begin to talk again, it is important to have other ways to
communicate. Here are some ideas that you may find helpful:
- Keep pads of paper and pens or pencils in your pocket or purse.
- Use a typewriter, computer, or other electronic device. Your words
can be printed on paper, displayed on a screen, or produced in a male or
female voice.
- Carry a small dictionary or a picture book and point to the words you
need.
- Write notes on a "magic slate" (a toy with a plastic sheet that
covers black wax; lifting the plastic erases the sheet).
The health care team can help patients learn new ways to speak. It
takes practice and patience to learn techniques such as esophageal speech or
tracheoesophageal puncture speech, and not everyone is successful. How quickly a
person learns, how understandable the speech is, and how natural the new voice
sounds depend on the extent of the surgery on the larynx.
Esophageal speech
A speech pathologist can teach you how to force air into the top of your
esophagus and then push it out again. The puff of air is like a burp. It
vibrates the walls of the throat, making sound for the new voice. The tongue,
lips, and teeth form words as the sound passes through the mouth.
This type of speech sounds low pitched and gruff, but it usually sounds more
like a natural voice than speech made by a mechanical larynx. There is also no
device to carry around, so your hands are free.
Tracheoesophageal puncture
For tracheoesophageal puncture (TEP), the surgeon makes an opening between
the trachea and the esophagus. The opening is made at the time of initial
surgery or later. A small plastic or silicone valve fits into this opening. The
valve keeps food out of the trachea. After TEP, patients can cover their stoma
with a finger and force air into the esophagus through the valve. The air
produces sound by making the walls of the throat vibrate. The sound is a lot
like natural speech.
Mechanical speech
You may choose to use a mechanical larynx while you learn esophageal or TEP
speech or if you are unable to use these methods. The device may be powered by
batteries (electrolarynx) or by air (pneumatic larynx).
Many different mechanical devices are available. The speech pathologist will
help you choose the best device for your needs and abilities and will train you
to use it.
One kind of electrolarynx looks like a small flashlight. It makes a humming
sound. You hold the device against your neck, and the sound travels through your
neck to your mouth. Another type of electrolarynx has a flexible plastic tube
that carries sound into your mouth from a hand-held device. There are also
devices that are built into a denture or retainer and can be worn inside your
mouth and operated by a hand-held remote control.
A pneumatic larynx is held over the stoma and uses air from the lungs instead
of batteries to make it vibrate. The sound it makes travels to the mouth through
a plastic tube.
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