pain of losing something is far more traumatic than not having it
at all! Who knows it better than the victims of throat cancer whose
world is silenced abruptly. `Citadel' meets Dr. Arun Dehadaray,
ENT specialist of Pune and currently the Head of ENT, J.J. Hospital
who is working with the latest breakthrough in the medical field.
"It's a pity that despite enormous advancements in the medical field,
cancer still instills the same lethal fear, though it is just as
curable as any other disease, barring its terminal stage," states
Dr. Dehadaray, Head, ENT, J.J. Hospital, Mumbai and the former associate
professor of B.J. Medical College. "But yes, the journey to a complete
cure is long and tedious, sometimes involving the surgery of the
malignant part. Unfortunately, in throat cancer, since the voice
box or larynx is infected, if the case crosses the curative stage
of radiotherapy, there is no alternative but to remove the voice
box. This eradicates the malignancy but the person loses the power
of speech for life. This is certainly a pitiable condition for the
patient," empathises this doctor who is working relentlessly in
his pursuit of making his patients vocal again. And his cause for
concern is not unreasonable. "Cases of the killer larynx cancer are going up at a startling pace, particularly so in the Mumbai-Pune
belt," reveals this Punekar who does not rule out the possibility
of some mysterious cause besides pollution and increasing smoking
habits, that is working overtime to spread the dreaded disease.
"After the surgery, patients are invariably very depressed because
of the loss of speech."
We suggest they gulp a lot of air and use it to produce some speech
which is known as oesophagal speech. It's like a person learning
to talk all over again. But ninety per cent of the patients fail
to develop it. In majority of the cases, an artificial device called
electrolarynx is placed near the throat and the artificial vibrations
produced are used by tongue to produce speech. "But," adds Dr.Dehadaray,
"the voice is very monotonous. Despite a lot of training, it defeats
the very purpose as communication is not easily understandable.
In fact, in Pune I had suggested electrolarynx to about fifteen
patients, but it failed to provide any succour. However there was
no choice since till some time ago this was the only standard metal
work available." Dr.Dehadaray further explains, "Once the larynx
is removed, a tracheostomy hole is left on the neck for breathing
as the continuity between the air tract is broken. Here, respiration
is not through the normal route - starting from the nose, passing
through the trachea (wind pipe) and going to the lungs and back.
In normal cases, air comes from the lungs, vibrates the vocal chords
and produces sound. This is then converted into speech by the tongue,
palate and lips.
"When the larynx is removed, there is no air going to the oral cavity,
so how can one find his voice?" he reasons. According to the dictates
of Science, in order to be heard, the air from the lungs needs to
travel to the oral cavity. Medicos believe that if somehow the windpipe
can be connected with the food pipe, which also opens in the oral
cavity, the air coming from the lungs can be diverted to the food
passage and ultimately, to the oral cavity. This air can then be
used to produce speech. He further clarifies, "There is a probability
that the connection between the food passage and air passage could
result in an increased risk of liquids or food particles going to
the air passage, thus leading to a lot of complications. So there
should be a valve in that connector which only allows one way movement
of air. And fitting the bill, they have what is called a Swedish
Provox Prosthesis. This is made-up of `silistic material' which
is accepted by the body. We've handled three cases so far and the
results have been remarkable," he enthuses about this major breakthrough
in the medical field. "If we can import this prosthesis and if the
surgery is performed accurately, it'll be a final solution to this
problem," announces the good doctor who has been introducing the
medical fraternity to this latest development through various presentations.
The procedure costs approx. Rs. 12,000/- for a patient. "There is
no cost difference between this and electrolarynx. More over it
has the advantage of being much more safe and efficient, while the
speech is lucid," the medico declares quietly.
An added advantage is that whilst undergoing primary surgery involving
the removal of the larynx itself, this prosthesis can be inserted
after making a tracheo-oesophagal puncture (TEP) and connecting
the trachea (windpipe) and oesophagus (foodpipe) with this dumble-shaped
device. "A fortnight after the procedure, we start the patient on
speech therapy. Within a week, the patient learns to close the tracheaostomy
hole with his thumb, forcing the air from the lungs to go through
the valve and into the food passage rather than escaping out of
the hole. This air is used to generate speech, using the tongue
and palate," Dr. Dehadaray explains. "One thing that has to be kept
in mind is that the prosthesis requires daily cleaning as there
are lot of secretions inside which can clog it."
Every morning, with the help of a special brush, one has to clean
the prosthesis just like the ritual of brushing your teeth. The
technique is very simple and involves putting the brush inside the
tracheostormy hole. And since it is accessible, it is no problem,"
the ENT specialist remarks. "This Swedish prosthesis is definitely
a major breakthrough. With more awareness about it in the medical
circle, and the right technique to use it, it would bring life back
into the patients suffering from cancer of the larynx in more ways
than one," Dr. Arun Dehadaray rounds off, rather pleased. - Geetanjali
Gupta Break : "This Swedish prosthesis is definitely a major breakthrough.
With more awareness about it in the medical circle, and the right
technique to use it, it would bring life back into the patients
suffering from cancer of the larynx."
Contact him at # ( 020 ) - 340025