Coping with Unexpected Change

Speech therapists are helping patients like Joy Williams regain communication and other skills after a surgical procedure

By Erin Brereton

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Joy Williams was diagnosed with a cancerous vocal chord tumor in 2011 and initially received treatment from a local physician in North Carolina.

When the cancer returned in 2012, Williams decided to seek care at Cancer Treatment Centers of America® (CTCA), Atlanta.

After several days of tests, Williams’ CTCA® doctor told her although the treatment he recommended, a laryngectomy, would involve removing her voice box, he’d have her talking again.

“That is what I needed—a light at the end of the tunnel,” Williams says. “When my surgeon told me he would have to remove all of the voice box, I was devastated. But he talked with me until he made me realize that it wasn’t the end of the world—just an adjustment.”

A Positive Perspective

After the operation was performed in November 2012, Williams received, and immediately began using, an electrolarynx electric voice box.

By the time she began working with CTCA® Speech-Language Pathologist Jennifer Cargile, MEd, CCC-SLP, in spring 2013, Williams had already mastered using the electrolarynx by reading books aloud and practicing with family.

She was concerned, however, people might not be able to fully understand her.

“Often, I have to encourage laryngectomy patients to interact with others,” Cargile says. “Joy was doing day-to-day activities as she always did. She was very intelligible, but she had researched and was very interested in getting a tracheoesophageal prosthesis to sound more natural when she spoke.”

Having a tracheoesophageal puncture (TEP) procedure is the gold standard for voice restoration following a total laryngectomy. Many patients have excellent results with a TEP, but research indicates up to 29% experience complications. During a TEP, a head and neck surgeon inserts the prosthesis, which has a small, one-way valve that allows for air to travel from the windpipe into the esophagus. A vibratory signal is produced that can be used to create vocal sounds.

After having the procedure, Williams began working with Cargile to learn to generate speech with the prosthesis, which eliminated the need for an electrolarynx.

“My speech therapist, Jennifer Cargile, has been there for me in every aspect of this journey,” Williams says. “She lifted me up when I didn’t think I could be lifted.”

Williams, according to Cargile, actually provided a significant amount of her own optimism, remaining characteristically positive when she received the unexpected news her body was rejecting the TEP prosthesis and it needed to be removed.

“Joy’s outlook on life, and especially her surgery, is inspiring,” Cargile says.

Offering Encouragement

After her TEP removal. Williams felt more confident about using her electrolarynx than before—so confident, Cargile says, that Williams now works with the CTCA  Cancer Fighters Care Net (CFCN). She happily chats with patients who are facing a laryngectomy or want to speak to someone post-surgery by phone or email.

Patients now strive to achieve Williams’ level of communication.

“Since Joy has become part of the CFCN, I have seen a complete change in the anxiety levels of patients who are soon to undergo surgery,” Cargile says. “We had a patient recently who attributed his decision to go forward with his laryngectomy to Joy. After speaking with her, he said, ‘If she can live a full life and do everything she is doing, so can I.’”

During and after treatment, cancer patients can experience a number of physical mobility, memory, energy level and other changes. Many don’t expect to have trouble with things like communication, as Williams did; yet some do, according to Cargile.

By working with speech therapists, patients can often rebuild a number of skills, ranging from their ability to vocalize to memory capabilities and being able to swallow again.

“It is amazing to watch a patient who was unable to eat by mouth for three months return to eating—or a patient who only communicated by writing for four months tell his wife he loves her,” Cargile says. “As a therapist, there is no greater satisfaction than watching someone get back what they lost.”