Head & Neck Cancer Support Group
Kirklin Clinic – Birmingham, AL
distributed by American Cancer Society, edited by Pat Sanders
Thursday, 12 Sep 2002
One year ago today I joined the ranks of the Larys. I am not a big one for anniversaries, but this one is going to be hard to forget. They blew up the World Trade Center Towers on the Tuesday, and they ripped out my larynx on the Wednesday. I have a feeling the news media will be reminding me of this anniversary for a lot of years to come.
I was feeling pretty sorry for myself before the operation, and the time in the hospital was difficult. Soon I was out of the hospital, and had to deal with the real world. Within days of getting back home, my support network vanished, and I had to get back to the task of living. My daughter (then 15 months) still got up every morning and someone had to play with her. Her breakfast had to be made and of course her diapers had to be changed. (At least now I don't smell them.)
Two weeks after getting out of the hospital I had my first TEP installed, and the last barrier to normal existence was removed.
A year later, it all seems like such a non-event. The sun still rises in the east, waking me up long before I consider appropriate, and sets in the west long before my daughter wants to go to bed. I now have to deal with the daily war against mucus, but that is more of an annoyance than a tragedy. My daughter now tries to talk by pressing her thumb into her neck with rather unsatisfactory results. I guess I should get a hands free device.
Overall, it seems that I have been happier in the last 12 months than I have been in years. The cancer and the laryngectomy are not the reason for this happiness, but contrary to my fears, they could not steal it away from me either.
Kevin Berry, Toronto firstname.lastname@example.org
THE RIGHT TOUCH IV
Fourth in a series of articles about self-massage and stretching
Hi there. We are here again in the series on stretching and self-massage. In the previous three sessions, we covered the chest and back, ribs and breathing apparatus, shoulders and neck. We discussed that there are various tools to use in massage and even incorporated a tennis ball and a towel in our sessions. You may want to consider reading, or having someone read, these sessions into a tape recorder and playing them back as you stretch or do self-massage. If you do so, then be sure to do it slowly, giving yourself time to do each of the movements or exercises.
In this session, we will focus directly on healing on and around the laryngectomy site. As you may know, there are different types of laryngectomy surgeries, and each has it’s own purpose and focus but these surgeries have in common the trauma on the tissues of the neck and surrounding areas. Lymph nodes and glands are often removed, destroyed, or aggravated. There is scar tissue, and radiation may have taken its toll on the skin and underlying tissues. I have found that the amount of self-care information offered to post-surgery patients does not include self-massage. Remember that this is YOUR body we are talking about here and it is time for you to realize that YOU are in charge of it! So, off we go! It is time to really explore and discover what your particular needs are around your surgery site.
To do this massage, you will need some cream or lotion. I prefer to use cocoa butter, which, in its pure form, is solid. Cocoa butter is very emollient and penetrates into the tissues as well, allowing for the perfect amount of friction necessary to do the massage. Pure cocoa butter is available at the beauty supply store and at most pharmacies. If you cannot find it, any cream is better than none.
In today’s massage, your hands will be your tools. You will sit in a very comfortable chair (a recliner is great) for this session. You can also prop yourself in the bed or on the sofa with lots of cushions or pillows for support. First, while sitting or standing, a little warm up exercise. Place the palms of your hands together about six inches in front of your chest, fingers matching, and point your fingers away from you. Your thumbs are pointing up. Spread your hands out, fingers still matching. See how wide you can make the spaces between your fingers Use the fingers on your right hand to gently stretch the fingers on your left hand by pushing them back, giving a good stretch through the wrist and then reverse the stretch. Hold to a count of ten on each side and repeat three times. Give your hands a good shake out. Gently pull each finger and each of your thumbs. Pinch all the way around the ends of your fingertips. Clap twice. Give your hands a brisk rub on both palm and back side. Now, on to the massage.
We will begin with a relaxation exercise. Reclining comfortably, close your eyes and watch your breath. Without changing your breath, you might notice that it gets slower and more regular by just watching it. Allow yourself a few breaths to let go of anything that is distracting you. Allow thoughts and images to come into the forefront of your mind, and then allow then to escape your immediate thinking by breathing them out with a breath of relaxing air. You might want to imagine that your lungs are filled by a large balloon, and that balloon fills from the top to the middle to the bottom as you breathe in, and that the balloon empties from bottom to middle to top as you breathe out. Filling top to middle to bottom and letting go from bottom to middle to top. Allow yourself a few breaths to get the sensation of letting go of any stress as you breathe out, and filling up with a sense of calm, relaxing energy as you breathe in. Filling up and letting go. Give yourself a few moments to deal with the images that come into your mind, letting them go as you breathe, and getting in touch with a sense of inner calm.
When you feel that you have let go of as many distractions as you can, turn your attention to your the area around your surgical site. Have you ever explored the soft tissues there? Reach up and feel the area from behind ears at your hairline around to your jaw. Gently rub in small circles, holding down the skin, rubbing the tissues just underneath the skin. Feel the bony structures and get a sense of what your particular tissues feel like. Are there sore spots? Give your ears a tug in all directions (they won’t pull off!) and even stick your fingertips inside and give them a rub. Use your thumbs to rub underneath your jaw right on the bone until you reach the chin. Are there sore spots there? Now, explore the area on the front of your neck, paying particular attention to your scar, still gently rubbing in small circles. Massaging scar tissue is especially important because scar tissue can bind tissues together impeding free movement between structures. After exploring your scar, work your way around the stoma site, feeling your collar bones, over and underneath. Do you feel as if you know your throat a little better already?
Time for the real massage. Into your reclining position, please. If you are using cocoa butter, you will notice that in its pure form, it is solid. You will need to rub it between your hands to warm it up, melting it enough to feel a little creamy. If you are using another cream or lotion, always rub it in your hands to warm it up first. The stages of this massage are: palpate (checking the tissues as in the previous paragraph), warm the tissues, apply friction, then, cleanse the tissues with sweeping movements. Palpation, warming the tissues and friction can be done in any direction, while sweeping movements will always go top to bottom, flushing lymph and any by-products of the massage into the lymph system for cleansing. Isn’t the body amazing?
To warm the tissues prior to friction, use the pads and tips of your fingers. I suggest using both hands for this part of the massage. Use just enough lubricant to allow your hands to slide over the tissues, being aware that too much will not allow you to feel what is under the skin, the area we want to really massage. Not using enough will cause too much friction. You can always add or subtract lubricant. We will begin by using the hands to spread the lubricant over the entire area we are working, which is from the chin, down the front of the neck to underneath the collar bones (clavicles),and out to the sides of the throat even with the earlobes. A note of caution: do not press deeply into any area on the front of the throat. You have major arteries and veins there and we want to avoid any pressure that might hamper blood movement. Rub the lubricant starting under your ears, working your way to under your chin, gently pulling the tissues forward. Stroke this area five times, ear to chin, spreading the cream evenly. Then using the pads and tips of your fingers, warm the tissues from the sides of your neck into your scar by gently pulling the tissues toward the centerline on your throat. Reach across your throat with your right hand, pulling the tissues from the left side toward the center, all the way from the outer edge of your collarbone to your stoma. Stroke each area five times, feeling each stroke a bit deeper as you go. Then repeat with your left hand on the right side. Give your hands a rest and shake them out.
The next part of the massage may feel strange, but with practice it will become more comfortable with time. Support your right elbow in your left palm, laying your right arm across your chest. Using your right hand, gently pinch the tissues on your neck together, two fingersfuls and a thumb at a time, gently rolling the tissues together, lifting the skin away from the underlying tissues. Breathe. Notice that some areas are more tender than others. These areas need special attention. Rub them for a bit longer until the tenderness subsides. Work around to your scar and give it special attention. Lifting, squeezing and frictioning the scar tissue allows blood flow to the scar to increase and increases mobility of the scar itself. Switch hands as needed so your hands don’t tire. Spend several minutes working this area, then turn your attention to your collar bones. Use your fingertips, holding down the skin and rubbing the deeper tissues. One at a time and cradling your elbow in your opposite hand, rub the left bone with your right fingertips, then allow your fingers to dip into the area above and beneath the bone. Sensitive? Rub in this area as deeply as is comfortable from the stoma to the shoulder, then switch sides. Any area that is particularly sore can have some extra attention.
Remember to breathe and take breaks as needed to keep your hands from tiring.
OK. Cleanup time. The sweeping motions in this session are as important as any massage you will ever do. Begin by using your entire right hand, crossed over to the left side. The sweeping motion will cover from under the ear all the way over and under the clavicle to the fold at the armpit, where there are lymph ducts galore. Sweep down only. Imagine that you are using a squeegee to push any undesired water off a windshield. Ready? Ten strokes down the left side of the neck, over the clavicle, toward the fold at the armpit. Shake that hand five times when you are finished. Change hands and repeat with the left hand crossed over the right side. Shake that hand out when you have finished. Give the backs of your hands a brisk rub. Give yourself a pat on the back for a gift well given and received.
* * * * * * * * * *