The 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