4 weeks out

We are rapidly approaching 4 weeks since I had the latest surgery.  Everything continues to progress nicely, I suppose.  I had a days worth of appointments last Monday, the 22nd of December in Houston at MD Anderson.  There were three appointments on the schedule, first was speech pathology, followed by the plastic surgeon and finished with my ENT surgeon.  The speech pathologist set me up with a new type of HME filter holders, this kind was adhesive backed and doesn't require a neck strap.  For those unfamiliar, I no longer breathe through my nose/mouth combo, instead I draw my breaths through a hole in my neck that leads directly to my lungs (the opening is called a stoma).  I am what is know as a neck breather now.  The nose has a couple of important functions that I no longer get the benefit of.  It filters the air that is headed towards the lungs and provides moisture for that air as it travels into the body.  I no longer have any natural means of filtration or humidification, therefore, I must replace that with an artificial means to accomplish these functions.  Until last Monday, I used a larytube, held in place with a cloth strap that wrapped around my neck.  The opening of the larytube holds a small, round filter/humidification insert that I change every day.  The adhesive pad simply sticks to my neck around the stoma and a filter cartridge is inserted and I can go about my day.  I like it much better than the tube/necklace combination as I barely notice that it is there during my daily activities.  The tube annoys my airway and makes me feel like there is always something in my trachea about two inches in and I feel like I need to cough much more often.  I still have to use the larytube when I sleep, but at least I have some options as I get used to daily life as a dumb neck breather.

My boys on their new trampoline

We went to one of the restaurants in the complex so that Jessica could have breakfast and got a call soon that my swallow study was scheduled shortly and we needed to head back over to one of the imaging areas in the main campus.  The swallow study was pretty cool and I was able to see a lot of the action in real time.  It involves sitting in an x-ray booth and swallowing a barium solution while the technician records video of my upper body as I chew and swallow.  There were two concentrations of barium solutions, one very liquid and the other the consistency of pudding.  Neither tasted good at all, but the pudding was revolting enough to cause some gagging, but I did swallow it.  Swallowing was deemed good enough to let me start eating food, but I was advised that I should take it easy and start slow.  Soft foods and liquids.  No cheeseburgers.  One step closer, but not quite there yet!
The visit with the plastic surgeon went well and they were able to remove the stitches.  They really did a number on my neck this time and I don't think having the stitches in for three weeks did me any favors.  The stitches came out easy enough and other than it taking an hour longer than it should have, the visit was uneventful.
From the medical center, we raced out to the Memorial City office to meet with my ENT surgeon.  This was our first visit to this office and it took some time to find it, but we made it and the entire visit didn't take too long.  Overall, the visit was good.  I got to talk with the surgeon and her PA, both of which I have known for too long now.  My surgeon reiterated how good she feels about the outcome of the surgery and the results of the pathology that we got back recently.  She always likes to give me warnings that I usually just shrug off but this time she actually chuckled a little and said "you aren't going to listen to me at all, are you?" as she gave me some of her guidelines on what I should and should not eat.  She talked a little about me being near water and I held my hand to my upper chest and said I would only get in the water that deep, to which she held her hand at her knee and recommended that I not get in deeper than that.  Somewhere in between is probably where I will end up, although I don't have to worry about that for a while.  I found out also that the voice prosthesis is not a done deal yet.  They need to see in the next CT scan results what the inside of my neck actually looks like and where everything is in order to know if they can punch the hole or not.  The problem is my pectoral flap that they moved and stretched in this procedure and it's location relative to the spot where they will have to punch the hole between my trachea and esophagus.  If it is in the way, I might not be able to have the prosthesis, but we will have to wait and see.  My official followup plan is to have a CT scan roughly 8 weeks out from surgery.  That will be the new baseline and will tell them more about the TEP procedure that I can hopefully have.  After the baseline CT, I will have a CT every 3 months to look for new tumor growth or trouble spots.  Other than that, it is just rest and recover.  
Still trying to get used to my inability to speak.  I get frustrated very easily.  Very, very easily.  I hate the electrolarynx, but I guess I need to get some practice with it.  I am reading a lot about esophageal speech, but it appears to be tough to master and take a long time to get good at.  There are options, but nothing will happen overnight.  I need to start doing some physical therapy and learn to massage out the fluid that builds up on the right side of my neck, but I am still just focusing on resting and getting used to my new life.  That seems to be enough right now.