The Turnaround

How Mary Greeley Rehab & Wellness helps people eat, drink, and speak more easily after head and neck cancer treatment.

A cancer patient once told Emily Fecht that speech therapy was “the tunnel at the end of the light.”

It was a comment colored with the hopelessness that can come when facing a serious illness. Fortunately, after a few sessions with Fecht, a speech pathologist with Mary Greeley Rehab & Wellness, the patient’s attitude completely turned around. He was talking better, his voice was stronger, and he was starting to be able to swallow with less discomfort. He had hope again.

“Cancer takes a toll, and some people are at rock bottom when they come to see me,” she said. “I tell my patients that all you can do is move up from here. Bear with me, keep coming back, and we’ll help you get better.”

Fecht works with people being treated for head and neck cancers and dealing with serious issues related to speech, voice, and swallowing that can result from surgery, chemotherapy, and radiation treatments. This therapy can help patients get back to regular foods with slight modifications, speak clearer, breathe better, avoid long-term use of feeding tubes, and retain flexibility in their head and neck, she said.

Bill Roth is one example. In December 2020, he was diagnosed with squamous cell carcinoma in his upper left jaw. This resulted in the removal of multiple teeth and surgery to remove the cancer and rebuild his palate.

He began his treatment with Fecht just prior to chemo and radiation, which began in April 2021. The cancer treatments caused hardening of his neck, dry mouth, and difficulty chewing and swallowing. He and Fecht started doing swallowing exercises, manual lymphatic drainage massage, and the McNeil Dysphagia Therapy Program. Fecht is certified in the McNeil program, which helps patients work their way through food trials, starting with dry swallows and graduating to solid foods.

The massage techniques are valuable because they help move lymphatic fluid that can build up following cancer treatment and cause lymphedema and eventual fibrosis.

“There are lymph nodes in that area of the head and neck, and they can be damaged by radiation and no longer automatically move lymphatic fluid throughout the body. That fluid can accumulate, which can lead to lymphedema as well as difficulties with breathing and talking,” Fecht said.

Working with Fecht was “an immense benefit,” said Roth.

Getting the treatment going early was important, too, said Roth’s wife, Sandy.

“We didn’t realize that as a speech pathologist Emily would be able to help Bill learn how to eat and swallow safely. Knowing she was helping us through his recovery made a huge difference,” she said.

Ideally, a head and neck cancer patient will be referred to Fecht prior to treatment. A few years ago, she put a team together including oncologists, radiation oncologists, cancer navigators, dietitians, speech therapists, ENTs, and others from the William R. Bliss Cancer Center and the Bliss Cancer Resource Center. The team meets periodically to review patient cases and discuss therapy options. The team is always looking for ways to improve patient outcomes and make the whole process easier for patients to navigate while dealing with this new diagnosis. This has also helped build awareness of the value of early speech therapy, Fecht said.

“We want them to come before treatment starts so we can decrease the risk of them having swallowing problems,” she said. “I will also measure their neck circumference and mouth opening to get baseline measurements that can be tracked for changes as the patient goes through treatment.”

Roth admits that he misses hamburgers and French fries with ketchup and mustard (the acidity of condiments can cause him problems). Still, he is now able to eat some favorites: oatmeal with cream, pasta with meat sauce, mac and cheese, ham salad, and pasta salad. If food is sufficiently moistened for ease of swallowing, he doesn’t need to alternate with applesauce.

He and his wife can also go out to dinner with friends, with Roth sometimes opting for just a salad with extra dressing. He may not be eating like everyone else, but he is a full participant in the occasion.