When David Trowbridge of Brevard had a sore throat this past October, he didn’t think much of it. He was prescribed antibiotics while on a visit to Florida, and assumed that would take care of it.
The sore throat persisted another couple of weeks, so when he got back to Brevard, Trowbridge visited his general practitioner, who referred him to Asheville Ear Nose and Throat. After a nasal scope and biopsy, Trowbridge got news that would shock him—his simple sore throat was actually squamous cell carcinoma, which was on his left tonsil, some of the soft palate of his mouth and expanding into the left lymph node of his neck.
“It was terrifying news,” said Trowbridge. “I have two young kids and couldn’t help but think of what life would be like for them without their dad. And my wife is a stay-at-home mom who also does a lot of charity work. I thought about how things would change for her if the worst happened to me.”
After receiving his diagnosis and getting an overview of his options, Trowbridge’s first instinct was to visit Mayo Clinic, which has a department devoted entirely to head and neck cancers. While the team Trowbridge met with was highly professional and knowledgeable, they ultimately weren’t able to offer him the course of action he was hoping for.
Upon returning, Trowbridge met with Michael Messino, MD, Medical Director, Medical Oncology at Mission Health, to go over a treatment plan, which would be a full seven weeks of radiation (35 treatments) with weekly chemotherapy. “I was extremely grateful to have Dr. Messino discuss my situation with me on a very personal level,” said Trowbridge. “He took such good care of me during the treatments, and focused on the best long-term outcome.”
Fishing a Way through Treatment Challenges
Trowbridge’s treatment period was a rough time for him. The process he underwent for receiving radiation involved having his head strapped down and positioned so that he couldn’t move it for at least 10 minutes each time he was in the radiation machine. This often induced intense feelings of claustrophobia. However, Trowbridge found a unique way to cope with the stress of being in the machine.
“I’m a lifelong fisherman, so I would replay fishing trips—in detail—during my treatments; this took my mind to my ‘happy place,’” he said. “During those 10 minutes, which usually seemed like an hour, I would also focus on future fishing trips and all the big ones that wouldn’t get away.”
Trowbridge said it’s really important to have a mental plan to deal with the treatments, but that the Mission radiology technicians also helped make the experience easier. “I can’t thank them enough,” he said. “They were terrific and made the experience the best it could be under the circumstances.”
Trowbridge also had to deal with the side effects of his treatments. The weekly chemotherapy eliminated his taste buds, caused everything to smell bad to him, made his neck very sore and left him with no appetite. He was on a liquid diet for about 10 days during the worst of it. As a result, Trowbridge lost 27 pounds during the treatment, even though he was trying to maintain his weight.
“The compassionate professionals at Mission reviewed all of the side effects with me and recommended ways to mitigate it,” said Trowbridge. “The treatment is not easy, and it takes resolve and dedication to see it through.”
Special Help for Recovery
Due to his weight loss, difficulty swallowing and other symptoms affecting his appetite, Trowbridge had the option of a feeding tube. However, after finding out he could become dependent on feeding tube use, causing his tongue and throat to atrophy, he decided that he would hold off on it for as long as he could. That’s when a speech-language pathologist and dietician stepped in to help him navigate eating on his own.
Speech-language pathologists (SLPs) are often associated with voice and communication, but they are also highly qualified in swallowing disorders and can help throat cancer patients sustain their swallowing capabilities during and after treatments.
“The role of the SLP is critical in helping people maintain or return to a safe oral diet post radiation,” said Patty Mabe, MS, CCC-SLP, Speech Language Pathologist at CarePartners. “We assess the current status of the patient’s swallow function via clinical evaluations and instrumentations. Then we establish an exercise program that will help reduce their risk of trismus (restricted oral opening post radiation) and maximize the strength of their swallowing muscles. We also use surface EMG-biofeedback, which is a visual feedback for muscle re-education.”
Not all throat cancer patients are able to maintain an oral diet during post radiation. In Trowbridge’s case, his relatively young age (55) and otherwise good health were on his side. Two other important factors that can impact a patient’s success in forgoing a feeding tube are the amount and location of the radiation he or she receives in the throat area.
“If an individual receives radiation to only one side of the neck, then the chances of maintaining an oral diet are greater because the unaffected side will most likely preserve the salivary glands, reducing the negative effects of dry mouth,” said Mabe.
It is also important that patients who are under the guidance of an SPL continue the flexibility exercises they’re taught. “These muscles can become fibrotic and hard, making it difficult to swallow years later,” explained Mabe. “To help prevent this, we work closely with lymphedema specialists who provide assistance with edema management, range of motion for neck and upper extremities, and education for self-management of these challenges.”
According to Trowbridge, closely following the SPL’s instructions has been critical to his recovery. “They [speech-language pathologists] are such an important part of the team,” he said. “I advise you to listen to their suggestions, read and review the handouts they provide, and do the exercises often.”
The Encouragement of a Support System
Trowbridge’s treatment and recovery strategies have been helping. He reported that he’s feeling pretty good, back to work part time, working lightly around the house and eating mostly soft foods. He’s also looking forward to planning many more fishing trips in the future.
“Having loving, supportive family and friends is so important because depression is a very real concern for this treatment,” said Trowbridge. “The text messages I received, emails, personal letters and phone calls from friends and family during the treatments really meant a lot—and at a tough time.”
“The speech-language pathologist and dietitian were godsends, the doctors were very compassionate and the entire staff in the chemo department were just incredible people,” Trowbridge said. “I believe God has some influence on the kind of persons who are best suited to treat cancer patients. He sure picked outstanding individuals at Mission Cancer Center. They are truly angels on Earth.”
Speech therapy can assist you with swallowing difficulties, in addition to voice, language, and/or cognition problems. Ask for a doctor’s referral or call CarePartners at (828) 274-6179.
Patty Mabe, MS, CCC-SLP, is a Speech Language Pathologist with CarePartners at the Mission Cancer Center. (828) 213-2168
By Jennifer Sellers