3/17 Team Care & Counseling

Question 1

What is the major pre-op concern of patients who are getting a laryngectomy?

Answer 1

“Am I going to Live?”

-Yes! The five year mark is the big boundary for cancer.

Question 2

What is the reason there is a big potential for cancer to metastasize or return to?

Answer 2

-the biggest potential is metastasis or returning potentially in the se place because all the cancer cells haven’t been removed

Question 3

What percentage of laryngectromy patients will live after the 5-year mark?

Answer 3

75-80%

Question 4

How is information gained when somebody has laryngeal cancer?

Answer 4

During the surgery through observation and getting a biopsy. Examining the larynx will give more solid answers.

Question 5

What is the primary fear of people who are diagnosed with laryngeal cancer?

Answer 5

death

Question 6

What should we make sure to not use with people diagnosed with cancer, and why?

Answer 6

Don’t use medical jargon when talking to them, these people are scared and may not attend very well.

Question 7

Unfortunately, the older you get, what is more likely to happen?

Answer 7

More likely that you will get cancer

Question 8

What are some things that we should tell our patients, and make sure that we know our patients are going through?

Answer 8

• Laryngeal cancer is highly cureable

- they have a fear of death

Question 9

What must we make sure to ask the patient in terms of medical concerns?

Answer 9

Ask them what they know, and what s/he’s learning from the doctor/nurse.

For pre/post op make sure to ask the patient what they already know. You will probably get some very bizarre answers

The patient may also know nothing!

Question 10

What must we always keep in mind when talking to a patient who has been newly diagnosed with cancer?

Answer 10

the diagnosis of cancer is SUPER HARD and often they can’t listen beyond their diagnosis. Don’t overload them with information. These people are very stressed so go slowly, and you may need to repeat yourself.

Question 11

What is something that we should tell a patient about their breathing when they are about to undergo a laryngectomy?

Answer 11

that they will no longer be breathing through the mouth or nose. There is no connection between the nose/mouth & trachea! The client will be unable to aspirate or choke!

Question 12

Why must we tell our patients that they have an excellent doctor?

Answer 12

Because state of mind is everything, this comforts them and makes them feel as if they will be okay.

Question 13

What is another thing we must tell our patients before their surgery?

Answer 13

describe the surgery and give some literature/printed material on the subject.

BRIEFLY describe the surgery, but give literature!!! These people are very frightened and overhwelmed

Question 14

How long is a laryngectomy surgery and what should we tell the patients what to expect when they wake up?

Answer 14

Tell the patient that surgery is 4-5 hours, when they wake up they will be in the ICU

• this is routine that they will be in the ICU–standard procedure!
• Tell them that they won’t have a voice and will need to communicate through writing. and that they will learn to talk again

Question 15

What is usually not an issue?

Answer 15

Pain

This is not a painful surgery but don’t tell your patient that! They are uncomfortable, but not in a huge amount of pain!!

Question 16

What should we tell our patients about eating after surgery?

Answer 16

• will be fed through a g-tube (nose tube) for a few days, then graduate to a soft diet, then a regular diet as the tissue heals
• this is standard procedure because they may not want food to go past the surgery site. They graduate to a soft diet (warn them about this), they will eventually graduate to a more normal diet as they heal. MOST patients will be able to eat normally again (definitely do not give them worst-case scenarios)

Question 17

What is the average stay in hospital after a laryngectomy?

Answer 17

5-6 days without complications

this is pretty long in current hospital terms, but you have to make sure the airway is maintained!

if there are complications, obviously you will stay longer.

Question 18

What are the two most frequently asked questions?

Answer 18

Why do they have to remove the whole larynx? Why not just a part of it, or just the tumor?

Why won’t I be able to speak

Question 19

How should we answer the question about not removing just part of the larynx?

Answer 19

• They remove the whole thing because it’s not going to work anyway. If you take out part of it, it will not do what it is designed to do and you have a higher risk of not getting all of the cancer (therefore, a higher risk of it returning)
• The larynx is a valve, if a valve is broken it either constantly leaks or doesn’t allow anything through it. with the larynx if you take out part of it, the larynx will leak and you will ASPIRATE!
• explain the behavior of the pharynx (and the valve)

Question 20

How do we explain to our client about why they won’t be able to speak?

Answer 20

• there will be no sound o r air coming out of the mouth
• there will be no way you can speak
• the absence of a larynx makes it impossible for vibration to happen. not even a whisper will exist.
• the trachea is unprotected when the larynx is removed so it is moved forward and you breathe through the stoma.

Question 21

What should we teach our patients when they cough and have a laryngectomy?

Answer 21

that they need to cover their stoma, not the mouth!

Question 22

Can laryngectomees blow their noses?

Answer 22

NO

Question 23

What is an issue that a laryngectomee experiences b/c they don’t have air going through their nose & Mouth?

Answer 23

The mouth and nose filter, warm, and humidify the air. because of the laryngectomy air is oging to the lungs colder, drier, and potentially dirtier.

Question 24

What is a good tip for SLPs and others to not do around a laryngectomy?

Answer 24

don’t stand/sit directly in front of them

Question 25

T/F You will tell a laryngectomy patient that there is only one method of speech to choose from, an electrolarynx

Answer 25

FALSE

there are several different methods of speech to choose from

Question 26

Describe Esophageal speech

Answer 26

you force air into the esophagus, it tens around again before it gets to the stomach, and it comes back out

Question 27

Describe esophageal speech that only someone who has a laryngectomy can do

Answer 27

they can use air pressure differential (normal people can’t do this) A laryngectomee expands their ribs with the stoma closed, forcing air into the esophagus. The esophagus has a positive air pressure (a little bit) as you expand the rib cage, you develop negative air pressure–creating a vacuum. The upper esophageal sphincter needs to relax and the air will sort of “plop” into the esophagus.

REMEMBER: YOU HAVE TO HAVE AN ABNORMAL MECHANISM

Question 28

What is the esophageal sphincter also known as ?

Answer 28

the cricopharyngeus

Question 29

How do most people use esophageal speech?

Answer 29

most people use tongue injection, literally swallowing a little bit of air.

Question 30

For esophageal speech, air is injected with a little bit of tongue pumping; literally swallowing a little air. What sounds are good for esophageal speech, and which one’s are a little bit harder?

Answer 30

/k,g,p,b/

/t/ & /d/ (a little harder)

Question 31

What percentage of people can “belch speech”?

Answer 31

roughly 50%

Question 32

Why is esophageal speech the best kind of speech, and what’s the problem with it?

Answer 32

it’s the best kind of speech because it’s hands free and you don’t need any devices, BUT it is the HARDEST

Question 33

May esophageal speech be done with a prosthesis?

Answer 33

Yes, it’s a TEP (tracheoesophageal speech/ you need a puncture for it & a prosthesis)

Question 34

Explain TEP speech

Answer 34

it’s a device connecting two tubes. It’s still technically esophageal speech b/c the esophagus is vibrating

Question 35

What are the two kinds of esophageal speech?

Answer 35

1. Esophageal Speech
   - no additional surgery
   - TEP (6 wks post laryngectomy is when you get a TEP)
2. Artificial larynx

Question 36

With an artificial larynx when can a lady become a pretty functional speaker?

Answer 36

in 6-8 weeks

Question 37

What does an electrolarynx do? and what must you do for an electrolarynx?

Answer 37

provides an electronic vibration

you do a lot of artificial therapy with these people, a lot of drill and kill!

Question 38

are there electrolarynxes that put the vibration in the mouth?

Answer 38

yes

Question 39

When can a TEP be done?

Answer 39

6 weeks after surgery

Question 40

How is speech therapy done?

Answer 40

it’s done on an outpatient basis, b/c you can’t do therapy until the swelling goes down

Question 41

What does cost of tx & number of sessions depend on?

Answer 41

the patient and their insurance

Question 42

What must we always do because most of our patients are elderly & don’t hear well, (remember: they don’t hear well & laryngectomy speech is quieter than normal speech anyway)?

Answer 42

part of your treatment should ALWAYS be checking the hearing of the patient and the people who live with the patient. hearing exams are important

Question 43

What must we make sure that a laryngectomee can distinguish between?

Answer 43

when your teaching laryngectomy speech your patient needs to be able to distinguish between a clear/unclear sound. If they can’t hear it they can’t make the distinction!

Question 44

Where the sessions are conducted makes a difference to what?

Answer 44

the price of tx

Question 45

What else depends on the patients ability to pay or the insurance’s willingness to pay?

Answer 45

of sessions

Question 46

What must we NEVER FORGET to do?!?

Answer 46

A HEARING EXAM!