Life After Surgery

The Stoma

I will now attempt to explain the consequences of the operation. As I have mentioned, I cannot speak properly may have been or are going through, but more importantly I breathe differently. I also have difficulty eating and swallowing. The operation involved the removal of my voice box and the insertion of a hole in my neck for breathing through. Obviously breathing is necessary to take in oxygen to stay alive. The removal of the voice box meant the flap that stops food and drink from entering the lungs was also removed. As a result, a separate hole needed to be made for breathing and the gullet was sealed off from the windpipe. To separate the gullet and the windpipe a new piece of gullet was made from muscle taken from my thigh and inserted by a plastic surgeon. All of it was a success. I can talk thanks to a valve fitted between the windpipe and the gullet. A hole is made during (or in some cases after) the removal of the voicebox, between it and the top. The valve (about 25mm long) is made of plastic with a flap at the back and fits into the new  hole.I will now explain how voicing works. 

A Typical Valve

In the voice box there are vocal cords that vibrate when air is passed through, and combined with the movement of the lips, a voice is made. Artificial voice is made the same way.The stoma that I have fitted allows air to enter lungs. A filter stops germs from that would cause infection, a job usually done by the nose and mouth. The filter needs to cover the stoma all the time so some form of fix is required.This is done with the aid of an adhesive plate.

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Typical Baseplates

The filter is called a humidity moisture exchanger HME. It stops germs from that would cause infection, a job usually done by the nose and mouth. The filter needs to cover the stoma all the time so some form of fix is required. This is done with the aid of an adhesive plate The filter is called a humidity moisture exchanger HME.a job usually done by the nose and mouth. The filter needs to cover the stoma all the time so some form of fix is required. This is done with the aid of an adhesive plate The filter is called a humidity moisture exchanger HME.  The plate is held in place by an adhesive on the back like a plaster. I’ve found that extra adhesive allows the base plate to remain without leaking for longer. I get it on prescription like all the appliances. It also doesn’t affect the skin.The sound of my voice is made much the same way as before, only now mechanically and not naturally. The HME acts in two ways.The first in its normal position allows air to pass in and out, and out, enabling me to breathe. The second, in a depressed position, stops air from going in and out as normal and forces it through the valve. As a consequence, the flap opens and movement of the lips allows air to pass out in the normal manner and the flap to vibrate. Thus speech is made. 

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The voice is a bit mechanical, like a Dalek. As a result, some people laugh and I get upset. cleaning and the base plate blows a lot more easily. In warm, dry weather it's fine. According to the specialist websites, I seem to be in the minority as most people seem to suffer more in hot, dry weather. Other things that affect speaking are food and drink. As they can only enter the stomach by gravity the back of the throat therefore acts like a funnel. The valve causes problems. Being alien to the body it causes the body's natural defences to kick in. This forms the increased production of mucus in both the lungs and the throat. The mucus from the lungs fills the valve and until it is cleaned out I can’t speak. The cleaning is done with the use of a prosthesis brush  The mucus seems worse in damp weather. I cough a lot, the valve needs Like a normal funnel, if it is full it takes time to empty. The piece of rebuilt gullet is like the cone of a funnel. At the top, if it is full food and drink cannot pass through the valve so speech is again affected. If air does get through speech is gurgally and most people cannot understand. The base plate acts like a gasket that is used in hydraulics. If the plate starts leaking (when it comes unstuck), air escapes via the passage of least resistance – through the leak. So no air passes though the valve making speech impossible. It usually happens in mid-conversation so all talk stops and I can't explain as I can't talk. People who are hard of hearing or who have poor eyesight have difficulty understanding me. I can't wear a tie as I like to have my top button free, so I generally wear granddad (collarless shirts). The things that have gone wrong so far are that the valve comes out. Usually If I have a Provox, a valve that has a tab to hold it stable when cleaning and a medallion to stop it entering the lungs if it comes out, I can usually refit it myself, but occasionally I can’t as the hole has shrunk. If I am fitted with a Vox, a valve that has none of the extra bits of a Provox Brush  but a wider flange to keep it in place, I can’t change it myself. I prefer the Vox as it is easier to maintain but I have gone back to wearing the Provox though for various reasons and most people think my voice is better. Another thing that can go wrong is when I lose all communication all of a sudden. This is usually caused by swelling in the gullet that covers the valve flap. This can normally be solved by a trip to the hospital to have the valve changed. The first time this happened I left it too long and the valve was forced out and the hole closed. Resulting in a six-month wait to go to hospital for an overnight stay and surgery to have the hole reinserted. So a lesson learned there. Normally things run pretty smoothly now I have got used to everything. Another problem that only arose three years after the operation was that I was diagnosed with an under active thyroid. That is controlled by one tablet a day. I have spoken on a lot of other websites. The general consensus is that it is quite common after the operation. It soon became apparent that the consultants were not really interested in the everyday issues that arise from having a laryngectomy. They are only concerned with the healing process after the operation and as my visits to the clinic became less frequent I have noticed that the doctors are lower down the pecking order. There are things I can't do, but now I’m 65 I have age-related problems. So apart from the issues with talking and the eating it's not so different. 

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It's neary four years since the operation to remove my voicebox. I get frustrated at times but I soon deal with that. My attitude is a lot better and I lead a fairly normal life  and I definately would not have a life if I did not have the op.

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