TALK BACK COLUMN - October 2001 Communiqué
Incomplete Care?
by Sue McMillan, S-LP(C),Toronto, ON
On April 6, 2000 my family’s collective lives were dramatically
altered by that dreaded word: cancer. My father, a strong, active
63 year-old, was diagnosed with unilateral tonsillar cancer
with penetration in one lymph node slightly inferior to the
base of the mandible. This was the beginning of what has proven
to be a long and challenging journey. It has also led me to
ask questions as a clinician.
Treatment followed this course: tonsillectomy (April 2000);
30 sessions of high intensity radiation therapy (May-July 2000);
unilateral neck dissection for removal of all lymph nodes (October
2000). Throughout this process, my father has experienced a
number of side effects, the most frustrating of which I describe
below.
On the final day of radiation therapy, he became aphonic and
remained so for over a month. My family was very worried and
I encouraged them to contact the ENT who was supervising my
father’s care. Upon doing so, they were told it was an
expected side effect that would “probably subside at some
point.” In the meantime, I donned my clinician’s hat
(from one thousand miles away) and provided my parents with
a list of vocal hygiene tips.
In addition to the aphonia, my father has a persistent dysphagia.
From June 2000 to date, he has been unable to successfully swallow
any consistency other than thin to semi-thick liquids. His diet
currently includes these liquids with occasional success in
swallowing vegetable soup and bread soaked in broth. At the
onset of treatment, his weight was 192 lbs.; today it is 142
lbs. Despite this dramatic weight loss, referral to S-LP, Registered
Dietician or Dysphagia Team has not been recommended at any
point in his care. He continues to be monitored by the ENT on
a bi-monthly basis. When inquiries have been made to the physician,
the response has been that my father must simply “wait
it out.” He continues to wait, with more grace and patience
than many could ever muster, I’m certain.
In conclusion, I would like to pose two questions to my fellow
S-LP’s: Are our specialized skills being sought frequently
enough to ensure improved quality of life for those who could
derive such from receiving our services? Based on my family’s
experience, I think not. So, where do we go from here?
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