Device Helps M.D. Speak After Larynx Cancer
CancerWise - February 2009
By Dawn Dorsey
As a physician, Dennis Welch knew it was a medical fact he would lose the ability to speak after his larynx (voice box) was removed surgically to treat cancer. But his feelings as a patient were much more complex.
“I was intellectually prepared, but I wasn’t really emotionally prepared,” he says. “I’m not sure if there is any way you can be ready. It still came as a shock.”
Hoarseness signals recurrence
Welch, 72, a medical oncologist in Austin, Texas, discovered he had laryngeal cancer (cancer of the larynx) three years ago after he was hoarse for several weeks. He smoked for about 20 years but stopped 32 years ago.
After treatment with radiation, Welch thought he could put the cancer behind him. But then the hoarseness returned, signaling the cancer was back.
This time, Welch was referred to M. D. Anderson, where he had a laryngectomy (surgical removal of larynx). Immediately after surgery, he couldn’t swallow and was fed through a tube in his esophagus. He also woke up without a voice.
“I had visited a speech pathologist before the surgery, and I was not looking forward to any of it,” he remembers.
Device restores speech
At first, Welch was given a little blackboard on which to write. Within a few days, the speech pathologist gave him an electrolarynx, which is a handheld, battery-operated device the patient places on the throat to produce vibration and make speech.
“I had speech, but it was not very satisfying,” he says. “I had to press the device to the larynx to talk. It was intelligible but not as effective as I would like, and it took a lot of practice.”
During surgery, the surgeon developed a tracheoesophageal fistula (a connection between the trachea and esophagus) to help Welch speak. Once the feeding tube was removed, a speech prosthesis with a one-way valve was placed between the trachea and the esophagus. The plastic tube between the trachea and the esophagus allows air to pass but prevents Welch from aspirating liquids or food. Speech started immediately.
“Speech is such an important part of life,” Welch says. “The prospect of having noneffective speech just was not acceptable to me.”
Chemo caused unpleasant effects
During surgery, lymph nodes in the area around Welch’s larynx were biopsied, and one immediately adjacent to the cancer site was malignant.
After surgery, Welch received more radiation followed by six weekly sessions of chemotherapy that included Erbitux®, (cetuximab), carboplatin and Taxol® (paclitaxel), which caused several uncomfortable side effects.
“It was not fun,” he says. “I developed peripheral neuropathy in my feet and fingers, which caused tingling and sensory changes, and severe skin rashes. I tried several products but got the most relief from aloe-based lotions. Weakness and fatigue also were significant problems.”
Like many people whose head and neck cancers are treated with radiation, Welch developed hypothyroidism (underactive thyroid gland), which contributed to his fatigue. He now takes thyroid-replacement medication.
Research can pay dividends
Back at work full-time, Welch has a clean bill of health and is disease-free one year after surgery. He will continue to have periodic checkups and CT (computed tomography) scans to keep a watchful eye on his health.
What’s his best advice to other patients who face a laryngectomy? Do your homework and find the right doctor.
“The big thing is to be sure you find a surgeon who is comfortable doing this type of procedure,” Welch says. “Don’t be afraid to ask questions. Also, find out what your voice options are. There are a lot of choices out there now.”
He ignores cancer and moves on
Welch says his life –– both personally and professionally –– is back to normal. Although he has to be careful of water exposure and can’t swim because of the danger of water entering his lungs, he’s back to business as usual.
“From the beginning, I made the decision to live my life as if the cancer didn’t exist,” he says. “Losing speech is a life-changing event, but it really doesn’t change your life that much. There are so many options, and basically most patients can return to their previous lives. If you’re a singer, it will impede your career. But otherwise, chances are good you can return to an essentially normal and full life.”