See these pages to read about lymphedema and hypertension.
Many cancer patients and survivors complain of pain. Pain can be one of the important signs of cancer and may even lead to its diagnosis. Thus, it should not be ignored and should be a sign to seek medical care. The pain associated with cancer can vary in intensity and quality. It can be constant, intermittent, mild, moderate or severe. It can also be aching, dull, or sharp.
All these medications have side effects (i.e., constipation with codeine), and should be taken under medical supervision.
Recent research have shown positive results for acupuncture in controlling pain. However, studies in people with cancer are often small and it is more difficult to be sure of the results.
Chronic head or neck pain after treatment can be debilitating and occurs in about 15 % of patients. Shoulder and neck pain are particularly common in those who also underwent neck dissection. It can cause functional limitations and contribute to unemployment in survivors.
- Acute and chronic pain control
- Dry mouth after radiation
- Muscle spasms, tremors, tics, contractures
- Peripheral neuropathy (also after chemotherapy)
- Lymphedema after radiation (preliminary studies only)
- Anxiety, fright, panic
- Cancer and chemotherapy related tiredness
- Drug detoxification
- Certain functional gastro-intestinal disorders (nausea and vomiting after chemotherapy, esophageal spasm, hyperacidity, etc.)
- Headache, migraine, vertigo, tinnitus
- Frozen shoulder
- Cervical and lumbar spine syndromes
- Persistent hiccups
Symptoms and signs of new or recurring head and neck cancer
Most individuals with head and neck cancer receive medical and surgical treatment that removes and eradicates the cancer. However, there is always the possibility that the cancer may recur; vigilance is needed to detect recurrence or possibly new primary tumors. It is therefore important to be aware of the signs of laryngeal and other types of head and neck cancer so that they can be detected at an early stage.
Signs and symptoms of head and neck cancer include:
- Bloody Sputum
- Bleeding from the nose, throat, and mouth
- Lumps on or outside the neck
- Lumps or white, red or dark patches inside the mouth
- Abnormal-sounding or difficult breathing
- Chronic cough
- Changes in your voice (including hoarseness)
- Neck pain or swelling
- Difficulty chewing, swallowing or moving the tongue
- Thickening of the cheek(s)
- Pain around the teeth, or loosening of the teeth
- A sore in the mouth that doesn't heal or increases in size
- Numbness of the tongue or elsewhere in the mouth
- Persistent mouth, throat or ear pain
- Bad breath
- Weight loss
A self-examination guide is available.
Individuals with these symptoms should be examined by their otolaryngologists as soon as possible.
Head and neck cancer spread
Laryngeal cancer like other head and neck cancers, can spread to the lungs and the liver. The risk of spread is higher in larger tumors and in tumors that had been recognized late. The greater risk of spread is in the first five years and especially in the first two years after the cancer appears. If local lymph glands have not revealed cancer the risk is lower.
Individuals who had cancer at one time may be more likely to develop another type of malignancy is not related to their head and neck cancer. As people age they often develop other medical problems that require care, for example, hypertension and diabetes. It is therefore imperative to receive adequate nutrition, take care of one's dental, physical and mental health, be under good medical care and be examined on a regular basis. Of course head and neck cancer survivors, like everyone else, need to watch for all types of cancers. These are relatively easy to diagnose by regular examination and include breast, cervix, prostate, colon, and skin cancer.
Low thyroid hormone (hypothyroidism) and its treatment
Most laryngectomees develop low levels of the thyroid hormone (hypothyroidism). This is due to the effects of radiation and/or the removal of part or all of the thyroid gland during laryngectomy surgery.
Several formulations of synthetic thyroxine are available, but there has been considerable controversy if they are similar in efficacy. In 2004, the US FDA approved a generic substitute for branded levothyroxine products. The American Thyroid Association, Endocrine Society, and the American Association of Clinical Endocrinologists objected to this decision, recommending that patients remain on the same brand. If patients must switch brands or use a generic substitute, serum thyroid stimulating hormone (TSH) should be checked six weeks later.
Because there may be subtle differences between synthetic thyroxine formulations, it is better to stay with one formulation when possible. If the preparation must be changed, follow-up monitoring of TSH and sometimes throxine (T4) serum levels should be done to determine if dose adjustments are necessary.
After starting therapy, the patient should be reevaluated and serum TSH should be measured in three to six weeks, and the dose adjusted if needed. Symptoms of hypothyroidism generally begin to resolve after two to three weeks of replacement therapy and may take at least six weeks to dissipate.
A thyroxine dose can be increased in three weeks in those who continue to have symptoms and who have a high serum TSH concentration. It takes about six weeks before a steady hormone state is achieved after therapy is initiated or the dose is changed.
This process of increasing the dose of hormone every three to six weeks is continued, based upon periodic measurements of TSH until it returns to normal (from approximately 0.5 to 5.0 mU/L). Once this is achieved, periodic monitoring is needed.
After identification of the proper maintenance dose, the patient should be examined and serum TSH measured once a year (or more often if there is an abnormal result or a change in the patient's condition). Dose adjustment may be needed as patients age or have a weight change.
- Speaking slowly
- Taking breaks between sentences
- Take breathes with the stoma not covered
- Speaking slowly
- Speaking only 4-5 words between each air exhalation
- Using diaphragmatic breathing,
- Over articulating the words
- Speaking by using low air pressure.
- Consuming a diet that will generate bulk and are high in fiber (fruits, vegetables and grain products)
- Staying well hydrated by drinking plenty of fluids
- Reducing dependency on laxatives
- Defecating after meals, taking advantage of normal increases in colonic motility after eating especially in the morning
a laxative. These include bulk forming
laxatives (i.e., psyllium or Metamucil, methylcellulose or Citrucel); osmotic agents (polyethylene glycol or
Miralax), poorly absorbed or nonabsorbable sugar laxatives (i.e., lactulose , sorbitol ), and saline laxatives (i.e., Magnesium
citrate); and oral
(e.g., Dulcolax, Senokot) and rectal stimulant laxatives (e.g., Dulcolax, bisacodyl).
- If possible avoiding medications that cause constipation (i.e., codeine)
Medical errors can be reduced by:
- Being informed and not hesitating to challenge and ask for explanations
- Becoming an “expert” in one's medical issues
- Having family or friends remain in the hospital
- Getting a second opinion
- Educating your medical provider about one's condition and needs (prior to and after surgery)
- Implement better and uniform medical training
- Adhere to well established standards of care
- Perform regular records review to detect and correct medical errors
- Employ only well-educated and trained medical staff
- Counsel, reprimand, and educate staff members who make errors and dismiss those who continue to err
- Develop and meticulously follow algorithms (specific sets of instructions for procedures), establish protocols and bedside checklists for all interventions
- Increase supervision and communication among health care providers.
- Investigate all errors and take action to prevent them.
- Educate and inform the patient and his/her caregivers about the patient's condition and treatment plans.
- Have a family member and or friend serve as a patient advocate to ensure the appropriateness of the management.
- Respond to patients' and family complaints. Admit responsibility when appropriate, discuss these with the family and staff and take action to prevent the error(s)
The Washington Post published a cover story in the Health Section on this topic which also includes my own experiences on May 7, 2013.
A Grand Rounds lecture entitled "Preventing Medical Errors: a Physician's Personal Experience as a laryngeal Cancer" that was delivered to the Department of Medicine Louisiana State University on April 16, 2013, can be viewed in YouTube.