My SLT Day: Head & Neck Cancer (Chloe Jarvis)
Thursdays are particularly busy days for the head & neck cancer team! We look after all patients with head and neck cancer, which includes areas like the tongue, tonsils, and voice box. Head and neck cancer can affect people’s ability to speak, eat and drink, which can also have a big impact on quality of life. My role as the Head & Neck Specialist is to help people get back to communicating and swallowing as best as possible.
To make sure the whole team is up to date on our patient journeys, we start each Thursday with a multi-disciplinary team meeting. This involves all members of the head and neck team, including ENT, Maxillofacial and Oncology Consultants, Pathologists, Radiologists, Clinical Nurse Specialists (CNS), Dietitians and Speech and Language Therapists. We go through our list of patients, look at the scans and biopsies to reach a diagnosis, and discuss treatment options. During this meeting we also link up with the head and neck team at Royal Cornwall Hospital to discuss joint cases, as sometimes their patients come to us for surgery.
Once the meeting is over, we head to the Head & Neck Clinic. Here, the team see patients either to give them their diagnosis or see how they’re doing after treatment. I see a patient who finished chemoradiotherapy a few weeks ago. They are struggling with pain in their mouth when eating. We discuss how best to manage this and what foods may be easiest to swallow.
I then get called to see a patient who has had a laryngectomy. This is where the voice box is removed, and the patient breathes through a hole in the neck. To give them a voice back after surgery, the patient has a small speaking valve placed into the tissue in the throat. This has been in place for almost a year and the patient has noticed it is starting to leak when he is drinking. I remove the speaking valve and replace it with a new one – hopefully this one also lasts for a long time!
In the afternoon I go to our post-treatment clinic with the Clinical Nurse Specialist and Dietitian, where we see a patient who finished radiotherapy last week. They are recovering well, but the skin on their neck is very sore. The CNS gives them some cream to use, and the Dietitian and I talk about textures of foods that may be easy to swallow and high in calories to help recovery. The patient leaves feeling reassured and should continue to heal over the next few weeks.
I make a quick visit to the ward to see a patient after surgery – they have had part of their gum removed. The surgeons want the patient to stay nil by mouth for a few days whilst the area heals. Once the surgeons are happy, I will check the patient’s swallow with liquids and then very smooth foods, like yoghurt, to make sure they are safe to eat and drink.
After that, I head back to the office to write up my notes, answer emails and wrap up all the admin for the day. I picked up a referral for a new patient during the multi-disciplinary team meeting so I make a file for them and will review them when they come to clinic next week. It’s been a busy day, but I loved catching up with patients and seeing them recover after treatment – the best part of my job is helping people rediscover the enjoyment of eating and drinking after difficult treatment. Our ability to swallow is so important – you don’t know what you’ve got until it’s gone!
My SLT Day: Newly Qualified Acute In-Patient SLT (Emma Hammett)
As an SLT working in the acute in-patient setting, we look after patients with communication and swallowing difficulties. Many conditions can impact people’s ability to speak, eat and drink, which can also have a big impact on quality of life. My role involves helping people get back to communicating and swallowing as best as possible.
A typical day begins by checking our systems for any referrals for new patients. These patients are discussed in our morning handover sessions where we review the patients on our caseload. We provide an overview of the patient, which gives an up-to-date summary to allow for others to take over their management if needed. I then spend time prioritising my caseload to decide which patients need to be seen first.
Once out on the wards, I will read through the patients notes to understand their current condition, what they have managed to eat and drink, how they have been communicating and what may be impacting this. I will then talk to the Registered Nurse (RN) or Healthcare Assistant (HCA) looking after that patient to find out further information regarding their communication, eating and drinking.
In the acute in-patient setting, a lot of our caseload primarily involves managing swallowing problems in our patients, also known as dysphagia. When a new dysphagia referral comes in, an assessment will be conducted by an SLT to determine what kinds of food and drink will be safest. When conducting these assessments, as Newly Qualified Practitioner (NQP) I am observed by my line manager. This allows me to develop and reflect on my clinical practice.
I typically begin a swallow assessment by conducting oral hygiene care. This involves clearing the mouth of secretions and debris. It is important to keep the mouth clean as secretions and foods are very harmful if they go down the wrong way. It will make patients very poorly, so it is important to manage. I will also assess a patient’s nerve function, to observe if any muscles of the face and mouth have been impacted. Assessing muscle strength helps determine what will be safe for the patient.
After this, I trial the patient on different types of food and drink to make sure they are safe to eat and drink. This involves trialling them on water and observing to see if they have difficulties with this. Thickener can be used in drinks; this allows for the drinks to move slower and is a safer option for some. I then check the patients swallow using smooth foods, like yogurt, gradually building up to more textured foods, like cake or biscuits, depending on how the patient manages.
Once I have assessed a patient and identified the types of food and drink that is safe for them to swallow, I will feedback to the RN or HCA to inform them of the changes. I also update the medical notes, so the rest of the Multi-Disciplinary Team (MDT) are aware of the patient’s recommendations. Back in the office, I update our systems, answer any emails, wrap up the admin and reflect on some of the patients with my supervisor to manage my CPD.
Each day working in the acute setting is different and brings about new challenges. In the few weeks I have worked as an SLT, I have already learned so much and begun to develop as a professional. I became an SLT as I wanted to work with people and be proactive. I have thoroughly enjoyed my time so far and look forward to developing myself as an SLT and working in such an interesting and important field.