You have been seeing a patient every two weeks while this patient is undergoing radiation treatment for head and neck cancer.  The 4th week into her treatment, the patient has developed mucositis. What recommendations or treatment would you suggest to help this patient for this side effect? 

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Mr. Ray will be undergoing a total laryngectomy.  Dr. Cummings referred the pt to you for presurgical counseling.  You provide him with information about pros and cons of each available postsurgical mode of communication.  Please imagine that you are talking directly to the patient and use the exact words that you would say to him during your session to explain the benefits and drawbacks of each listed mode of communication.   1.  Esophageal speech:     2.  Artificial larynx:     3.  Tracheoesophageal speech:

Lymphedema is accumulation of lymphatic fluid which contains excessive ____________________.

Describe one anatomic or physiological problem a patient may have that would impair swallowing following a total laryngectomy.  What interventions could be beneficial for this problem?  

Mr. Smith had a T3N0M0 glottic cancer and underwent total laryngectomy with bilateral modified radical neck dissection 3 weeks ago.  He never had preoperative radiation and there is no plan for postoperative radiation.  He had a primary puncture during his surgery and currently has a 16 French catheter in his TEP which is being used for tubefeeding.  He just saw ENT and the surgeons did a swallowing test in the clinic and have cleared him to eat and drink, pending your approval.  The surgeons also have cleared him for removal of the catheter and placement of his first voice prosthesis.  He comes to your clinic after his ENT appointment with his wife. His neck and lower face appear mildly edematous but his incisions appear well-healed.  Both the patient and his wife seem anxious and are eager for him to begin to eat and talk.   1.  Explain the steps you would take in terms of assessing his swallowing ability.  How would you determine if it was safe for him to eat and drink? 2.  Explain the steps you would take in fitting him with his first prosthesis. (You do not need to be specific about which prosthesis you would select) 3.  Once you place the voice prosthesis, the patient is unable to achieve tracheoesophageal voicing with thumb occlusion of his stoma.  Why might this be occurring?  What steps would you take to troubleshoot during your clinic visit? 4.  How would you counsel the patient and wife if voicig could not be acheived during the visit?  What would you do or expect going forward? 5.  What other educational needs might the patient or family member have at this point?  What else do you want to teach or explain?  

Mr. Jones is a 63 year old man who is undergoing chemoradiation for a T2N1M0 supraglottic cancer.  He is currently in his 4th week of treatment.  You are seeing him every 2 weeks.  At the last visit, he was doing well, eating a regular diet and feeling good.  Today, he reports that he has throat pain and severe dry mouth.  He has been eating less due to pain and loss of appetite.  He has lost 7 lbs since your last visit.  He is also not drinking much liquid.  He is complaining of redness and pain of the skin on the sides of his neck.  He’s not really brushing his teeth because of pain on the inside of his mouth.  He also reports that most foods taste bad and nothing seems appetizing.  He feels that he can’t do his swallowing exercises right now because he is simply not feeling very well and has a lot going on in his life in terms of his cancer treatments.  Also, he is experiencing pain when trying to do the exercises.  Mainly he is drinking a couple of Ensures each day.  He is still smoking because “It’s the only thing that seems to help me feel better”.   Given his active cancer treatment and current symptoms, is Mr. Jones a good candidate for speech pathology intervention right now?  Why or why not? What are some concerns you might have about Mr Jones right now in terms of his behavior during treatment?   What are some intervention options you could explore with Mr. Jones to address some of his symptoms and problems?  Are there other professionals you would refer to or collaborate with?  Explain.    

Which factors can influence smell and taste perception?  

True/false.  Recurrence of cancer needs to be the first thought if there is a change from the “new normal” following any treatment.

True/false.  Swallowing exercises are not beneficial for a total laryngectomy patient.