Laryngectomy Post Op Care In The Home Environment
A laryngectomy is a procedure where the larynx, often the voice box, and other major strictures have been removed, often due to cancer or major injury of the throat. It can be challenging to cope at home with a laryngectomy, but one can get use to this and live a fairly normal life. The patient will almost always have a permanent tracheostomy, or hole in the throat.
Things which will change the life on the laryngectomy patient, involve things like communication, which can alienate the patient from society if this is not addressed early on. Different tools are available, e.g. a little machine commonly known as a speech device or Electrolarynx, picks up the vibration of the throat muscles and with some practice, the patient can communicate through this. Modern phones provide an “app” which can be downloaded, “Text-to-talk”. The patient types into the phone and the phone will speak out load what has been typed. A small computer ( e.g. A mini ipad) can also be used, especially for communication during travelling. A wireless mini keyboard helps the patient type while the ipad can be attached to the window. It is advised that communication with the driver is kept to a minimum as the driver needs to concentrate on the road. Communication boards (white boards) are available in different sizes and this is very useful with an erasable whiteboard pen. Any other book and pen is useful also. Don’t over-estimate the ability of society’s lip reading. Only a very few people can lip read and this can cause a lot of frustration for both patient and family members. Rather make use of a different tool, even if it takes a little more time.
The laryngectomy patient will never be allowed to swim. Any water down the stoma ( hole in the throat after surgery) will cause the patient to drown, unless he has a very strong cough reflex to cough out the water which went down the airways. This brings us to showering at home: a special laryngectomy shield is available. This piece of equipment is usually made of soft rubber and straps around the neck like a baby bib. It has little holes for breathing, but this is at the bottom of the specially shaped shield where water will run down and not into the patient’s lungs.
Normally humans breath through the nose, which moisturizes the air before it goes down to the lungs. With the laryngectomy patient the nose is not used anymore for breathing, and an artificial way has to be used to moisturize the oxygen going into the lungs. For this it is of high importance to purchase a nebulizer. The patient has to nebulize very regularly, sometimes 2-3 hourly. We normally produce secretions, and if this is not kept moist, the patient can dry out and block off, resulting in inability to breath. The only way to get rid of the secretions is for the patient to cough it out. If a blockage occurs, a trip the hospital will have to be done as soon as possible. Normal saline 0.9% is used in the nebulizer, and can be purchased from the pharmacy. A portable device is also available – this can be expensive but as the normal nebulizer works with electricity, a portable unit will give the patient freedom to move around freely without having to worry about nebulizing. Different weather conditions require different frequencies in which nebulizing is required. If an aircon device is running, remember that this dries out the air and nebulizing should be more frequent. Secretion crusts can occur and build up very quickly. Make sure to seek help if even the smallest blockage occurs and if coughing does not get rid of the plug.
Sometimes a small shoulder bag can be used to keep some tissues, the portable nebulizer, a small communication board and pen available. The laryngectomy patient cannot blow his nose anymore and often the sinuses can cause a runny nose. Tissues can help the dry up the nose.
Some patients feel self-conscious about the stoma. A scarf, high collar shirt or jewelry can be used to get attention away from the neck. Little breathable patches to stick over the stoma are available but can be quite costly.
Living as a laryngectomy patient, or as a family member does not have to be challenging. At first it feels as if one will not cope but over time it does get easier. Don’t feel embarrassed to seek professional help to help you cope. This is usually a major event in anybody’s life but it can get easier over time.
About the author:
Paula Jansen van Vuuren is a registered nurse practitioner, qualified in 1979 and has 5 post graduate qualifications (UNISA). Worked in Intensive Care Unit since 1981. Obtained personal experience with laryngectomies when a close family member had radical throat surgery, and she was closely involved with post-operative care management.