LARYNGECTOMY FAQ'S

What about swallowing and dry mouth?
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

Doc, we are getting a lot of requests for help with swallowing and dry mouth. How long will this last and what can we do to get through it?

O.K. It looks like you want some help getting through radiation therapy. In previous issues, you have touched on some of the most basic things-diet modification, Ensure and similar products, BLADES as we call the blender, fresh fruit and the like. You are on the right track.

Just like surgery, radiation causes a wound that requires adequate nutrition to heal properly; and remember that even though radiation does not kill cancer by heating the cells, the side effects of the therapy are identical to a burn. Burns are some of the most physiologically demanding wounds and can effect metabolism in the most profound ways. And since these wounds are actually bigger and cover more surface area than a surgical incision, their nutritional and metabolic demands can be profound indeed.

First of all, I hope that those of you who are in this situation and are smokers got the message that the reason you are in this predicament is very likely due to your tobacco consumption. Therefore, for once and for all, use the problems that you are having with radiation to QUIT SMOKING. Use the analogy of burning leaves in the fall. Remember that wonderful smell as the smoke billowed off of that pile of burning leaves? Then remember what happened when the wind shifted and the smoke got in your eyes? IT BURNED, didn't it!! And exactly what is a cigarette but a concentrated bunch of burning leaves, right? Folks, we're not talking rocket science here.

Next, let's talk about all that thick, ropy mucous that is building up in your mouth and your throat. In our practice at UAB we are big believers in the powers of CLUB SODA. During our training as interns and residents we used sodium bicarbonate to clean out endotracheal tubes for patients in our intensive care units. That stuff was great at cutting the thick, tenacious mucous that would build up in the tubes.

Club soda, or carbonated water, has the same properties. When used as a mouth wash and a gargle it does a great job in cutting through the goo. You can also use it as a beverage for meal times as it seems to have superior wetting properties when compared to water alone. Buy the small 12 ounce bottles and keep them chilled. It won't work if it looses it's fizz. Try it, you'll like it (hopefully).

Lastly, let's talk some serious nutritional delivery for a moment. Let's face it, radiation is no walk in the roses, although in the RIGHT setting it can do just as good as surgery for treating cancer in the head and neck. All of the acute or short term side effects of radiation add up to make eating and drinking less than a pleasurable experience.

Actually, food becomes more like medicine than anything else. But remember, nutrition is the key to not only to a speedy recovery, but it also plays a large role in your ability to ultimately kick your cancer because you are keeping your immune system intact and healthy as well.

The bottom line is this: if things get too bad and your weight starts to fall off rapidly, then you really might want to consider some sort of feeding tube to help you through the short term. At UAB we rely almost exclusively on the PEG or Percutaneous Endoscopic Gastrostomy to help our patients. In fact, we often put this in before radiation even begins, just so we know that we can keep a patient's nutrition up from the get go. We think that it really makes a difference. So if you really are getting in trouble, get a tube.

You should expect the recovery from radiation to take anywhere from 3 to 12 months, depending on where exactly you received your radiation. Folks who had their mouthes radiated will take longer than those who received it only to their larynges. Hang in there. We know it's is tough and we are pulling for you.