Speaking Again: A Physician’s Laryngectomy Experience I am an infectious diseases physician with a special interest in head and neck infections and extensive experience in otolaryngological ailments. Four years ago I was diagnosed with hypopharyngeal carcinoma; when the tumor recurred two years later I had a total laryngectomy with a free-flap reconstruction. Becoming a throat cancer ... From My Perspective
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From My Perspective  |   September 01, 2010
Speaking Again: A Physician’s Laryngectomy Experience
Author Notes
  • Itzhak Brook, MD, MSc, is a professor in the Department of Pediatrics at Georgetown University School of Medicine. Contact him at ib6@georgetown.edu.
    Itzhak Brook, MD, MSc, is a professor in the Department of Pediatrics at Georgetown University School of Medicine. Contact him at ib6@georgetown.edu.×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / From My Perspective
From My Perspective   |   September 01, 2010
Speaking Again: A Physician’s Laryngectomy Experience
The ASHA Leader, September 2010, Vol. 15, 36. doi:10.1044/leader.FMP.15112010.36
The ASHA Leader, September 2010, Vol. 15, 36. doi:10.1044/leader.FMP.15112010.36
I am an infectious diseases physician with a special interest in head and neck infections and extensive experience in otolaryngological ailments. Four years ago I was diagnosed with hypopharyngeal carcinoma; when the tumor recurred two years later I had a total laryngectomy with a free-flap reconstruction. Becoming a throat cancer patient was a new, different, and challenging experience. I endured the consequences of radiation, repeated surgeries, and prolonged hospitalizations. Being able to speak again was not only the greatest challenge for me, but regaining this formerly simple ability became the most important part of my recovery.
I am sharing my experiences with speech-language pathologists to illustrate the numerous difficulties laryngectomees face and how dependent they become on SLPs’ continuous support and care—especially in the immediate post-surgical period.
Even though I was told prior to surgery that I would be able to speak again using a tracheo-esophageal voice prosthesis (TEP), I could not truly appreciate how it would feel to lose my vocal cords. I depended on my voice to communicate with the world—my family, friends, and patients—and, most of all, to teach.
The task of speaking again was most challenging and frustrating. I was unable to speak for more than two months, and later wished I had used an artificial larynx (electrolarynx) during that period. I was fortunate to be guided initially by a very knowledgeable SLP. However, when I returned home, I depended on a less-experienced clinician who did not respond promptly to my inquiries. I encountered many difficulties managing my TEP during that period and depended on her support and guidance. Receiving prompt help and guidance was both a practical and emotional necessity.
During that period I communicated with several local and out-of-town SLPs who were extremely forthcoming in attempting to assist me. I realized that this field is not only a science, but an art. Different SLPs used different approaches, which made it difficult to know whose advice to follow. I also found that many otolaryngologists were unfamiliar with TEP management and relied on SLPs to make most of the decisions.
I faced many frustrating new realities that included being unable to speak while eating; always having to carry airway supplies; mastering the art of sealing the housing of the heat-moisture exchanging filter; continuously maintaining the stoma and the TEP; and speaking again using the TEP. I also had to deal with the fragility of my speaking ability, the challenges related to the TEP’s repeated failures, others’ difficulties understanding my weak voice, and often overt or discreet discrimination from others. Fortunately, these difficulties lessened significantly with the passage of time and the reduction of neck edema.
Of the many challenges related to the rehabilitation of my voice, the most profound difficulty has been the emotional toll. I am unable to vary my speaking tone to express emotions or to alter the intensity of my voice. I can no longer audibly laugh or cry. I am disappointed when I am unable to give voice to my happiness, anger, or frustration, and consequently, many of these emotions remain bottled up. At times, I become angry and upset in situations in which I previously could explain myself better without getting irritated. Writing manuscripts and a book about my experiences as a patient helped me express myself and compensate for my speaking difficulties.
I eventually regained my ability to speak and even lecture with the help of dedicated SLPs. This process was long and often difficult and involved many setbacks and frustrations. Even though my new voice is weak and rusty I found a new use for it. In addition to my return to teaching, I devote much of my time to speaking with laryngectomee patients and health care professionals including SLPs and otolaryngologists. I explain how the compassion, empathy, and concern of SLPs, nurses, and physicians can help their patients’ recovery.
Most of all, I feel invigorated by the positive responses to my presentations. I have found a new mission that turns my weakness into a strength and my whisper into a message that has the power of a shout.
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September 2010
Volume 15, Issue 11