As a head and neck oncologist much of my time is spent meeting with other healthcare professionals outside of our clinic, most of whom I have known for quite a long time. Effectively this is themultidisciplinary approach, where a team of specialists and allied health workers discuss and decide the best care plan for any one patient. For a head and neck ENT clinic like ours it is essential that the team includes an experienced speech pathologist.
When a malignancy requires the total or partial removal of the voice box (larynx), I know I’ll soon be having a discussion with Therese Dodds. She is our speech pathologist, and we have collaborated for over 14 years. Over that time Therese and I have developed a kind of ‘shorthand’ method of discussing cases so that we can quickly agree to a patient’s requirements. And since a significant portion of patients will be from the regions this will even extend to patient logistics. Organising appointments to ensure as few visits to Sydney as possible relies on tight co-operation.
Therese’s involvement with patients might last for years. She will often see more of them than I or the rest of the team do. Even before surgery most patients will meet Therese so that she can help them fully understand the consequences of laryngectomy and the specific post-operative training they will undertake. Later on in the patient’s journey as they adjust to life without a larynx and are perfecting their method of alarangeal speech, Therese and I will commonly conduct joint consults to assess their progress and deal with any complications that may have arisen.
The value of speech pathology cannot be underestimated. The quality of life for a patient who has undergone a laryngectomy is strongly related to their ability to speak and swallow. For most this will mean learning to use and live with a voice prosthesis. Basically a shunt valve that is inserted into a small hole created surgically between the trachea and oesophagus - referred to as the tracheoesophageal puncture (TEP). Others may require the electrolarynx, the external device that transmits vibrations to the throat producing sound that can then be articulated into speech. If the patient is unsuitable for any device driven speech, then oesophageal speech, whilst difficult, is also an option. The training required for any of these options and the fitting and use of voice restoration devices is the domain of the speech pathologist.
Yes it is true that all speech pathologists treat a broad range of disorders that ultimately impair communication and swallowing. But not all speech pathologists take on laryngectomees. The underlying disorders can be challenging and the post-op care is usually long term. In the head neck cancer context the specific skills required rely heavily on the therapeutic alliance. Speech pathologists like Therese get the best results possible from their patients because they empathise and support them through what is typically a demanding rehabilitation. Losing your voice and then learning to use a “new voice” can be extraordinarily frustrating and, for many, emotionally distressing. Understandable when you consider that your spoken language is arguably the most important part of your identity. You need it for almost every human interaction.
Nowadays Therese is the Director of Speech Pathology at St Vincent’s Private and the Director of Eastern Suburbs Speech Pathology so she is pretty busy. Thankfully we are still collaborating and her efforts go a long way to ensuring that we get the best outcomes for our patients.
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