Trouble Talking by Daniel R. Boone

Author:Daniel R. Boone [Boone, Daniel R.]
Language: eng
Format: epub
Publisher: Rowman & Littlefield Publishers
Published: 2018-02-20T16:00:00+00:00

Tale 4: I Can’t Laugh or Cry

Roberta, a 54-year-old black divorced mother of three teenagers, was kidded continuously about her low-pitched voice. She had for years worked in a downtown Denver coffee shop and was able to support her family from alimony monies, wages, and some very good tips. Unfortunately, she had developed a habit of smoking, consuming nearly two packs of cigarettes a day. In her busy life, she was able to balance her mothering duties with church responsibilities and her lunch and evening work as a waitress.

As her hoarse voice deepened in pitch, she also developed an annoying cough. Since waiting on tables limited her ability to cough when she wanted to do so, she did two things: She coughed as lightly as possible in public, or made frequent trips to the employees’ restroom where she could cough heavily enough to clear out the offensive mucus. It was her coughing problem, not her deep voice, that forced her to seek medical attention.

The ENT found that Roberta had extensive cancer of the larynx, severe enough to require the surgical removal of her entire larynx (laryngectomy). This would require breathing through a surgically created opening in her neck (tracheostomy), plus the need for developing a new substitute voice (esophageal speech). The very day that she was told of her cancer diagnosis, Roberta vowed to quit smoking (and has never had a cigarette since). To help Roberta understand what she was facing, she had several pre-surgical visits from two women who had received the same kind of operation and had made wonderful recoveries. They each spoke to her with their new voices, describing how their family lives and work experience had continued on very well. Their inspirational stories convinced Roberta to proceed with her total laryngectomy—the total removal of her larynx, or voice box.

Roberta had a successful laryngectomy operation, followed by some radiation therapy around the operative site. The surgeon helped her develop a new substitute voice by making an opening between her windpipe and esophagus, and then inserting a small plastic tube through the opening, enabling her outgoing breath to flow into her esophagus. Once in the esophagus, this air can then escape through the esophageal sphincter, the muscle opening at the top of the esophagus. When expired air passes through this tight opening, it produces a burp sound. This is the same mechanism any person uses whenever we belch out air. In the case of the laryngectomy patient, this air-sound is used as a substitute voice. Patients who are good at using this esophageal voice can often say six or more words at a time on one continuous belching sound.

With the referral of one of the laryngectomy visitors who had visited Roberta before the operation, she began receiving voice therapy lessons with a speech-language pathologist (SLP). The SLP worked with her to increase the amount of air she could use for vibration of her esophagus. In a few sessions, she was able to say two words at a time, particularly words that began with explosive sounds like /p, b, t, d, k, g/.

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