19 Jun 2015
Cancer and hearing loss. These are words that don’t have a strong association in our vernacular. When you or a loved one is battling cancer, there are other concerns that take centre stage. Working in an oncology and palliative floor at the hospital, I’m acutely aware of the physical and emotional distress that the cancer survivor and their loved ones go through.
One area that’s often overlooked due to the medical urgency of cancer is discussions around quality of life. Chemotherapy drugs are often effective at treating some cancers, but they can have a lot of negative side-effects on the person. One of them is it being harmful to the ears, in other words, ototoxic. Specifically, some platinum drugs such as cisplatin is highly ototoxic and this is well documented in research.
As a healthcare provider, I’m an advocate for improving one’s health but I feel one’s quality of life is just as important. Especially when someone has survived cancer and there may be a risk or recurrence or new disease, you want to optimize their social and emotional well-being by ensuring they have the tools to communicate well.
A well-known researcher in the field of ototoxicity and Audiology, Dr Kathleen Campbell, has experienced this first hand with her family member and reinforces the importance of monitoring someone’s hearing throughout their cancer journey when treated with these ototoxic drugs (read her interview here). Not only is regular monitoring important, but also providing these individuals with digital hearing aids that can accommodate the changing hearing loss through their cancer journey. It’s just as important for them to be able to stay connected with their loved ones as it is for them to continue fighting.
So what would be considered an ototoxic event? The American Speech-Language Hearing Association (ASHA) defines a significant ototoxic event as meeting one of the three criteria:
a) more than 20 dB decrease at any one test frequency
b) more than 10 dB decrease at any two adjacent frequencies, or
c) loss of response at three consecutive frequencies where responses were previously obtained.
If this is duplicated after 24 hours, then it’s considered an ototoxic change.
Who can determine these side-effects? A licensed Audiologist would be able to test your hearing and monitor these changes and have frank discussions about the status of you or your loved one’s hearing ability.
Dr Campbell suggests regular monitoring before each round of chemo and after the full course of treatment. That way, a baseline can be established and any changes because of each chemo treatment session can be documented.
This is particularly important for children, since they are at greater risk of ototoxicity than adults. These children should have long-term audiologic follow-up when a hearing loss is detected during and after chemotherapy.
June is National Cancer Survivor Month. Focusing on the fight against cancer is very important, but let’s not lose focus on the person and their need for connectedness throughout their journey.
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*Image courtesy of winnond at FreeDigitalPhotos.net
17 Jun 2015
“Imagine if the last word you say tonight is the last word for the rest of your life”. This is the slogan that Stephen Goff is seen holding up during his moving presentation along with his wife, Carol Goff. Stephen was a very successful businessman in both Canada and the United States and was in no way, short of words. Then he suffered a stroke in 1994 on the left side of the brain that left him with aphasia and unable to speak, read, write, and work with numbers.
I had the pleasure of meeting Stephen and Carol at a recent talk they did at the hospital I currently work. They were the main speakers for our May Speech & Hearing month event and over 200 people were in attendance. Stephen wrote key words to get his message across with the occasional verbal word to emphasize his message, and Carol then interpreted the message for the listeners. The audience was captivated at what he had to say with the help of his wife, and thanks to them, more people have been educated on the effects of aphasia.
June is National Aphasia Awareness Month. Aphasia is the loss of ability to speak, understand, write, or read due to damage in the brain. This damage could be from a traumatic brain injury, stroke, tumor, or even degenerative diseases such as Alzheimer’s. The damage is in the language centres of the brain, which in most people is in the left hemisphere. Aphasia itself does not affect intelligence, but due to the limited awareness of the symptoms of aphasia, people are often mistaken for having intellectual impairments. Over 100,000 Canadians live with aphasia and about 1/3 of stroke victims experience it.
*Image courtesy of samuiblue at FreeDigitalPhotos.net
Since communication is so important to us and our relationships, those with aphasia will often feel isolated and depressed. It is important for those individuals to receive speech therapy to help them improve their ability to communicate.
I have worked on stroke and rehab units in hospitals as well as on a specialized stroke team that treated people in their homes. There are great programs that are offered through the hospital either through the rehab unit or in outpatient therapy programs. Unfortunately, once a patient is discharged from the public system, the individual or family members do not know the person with aphasia can further benefit from ongoing therapy. Conversation groups or Aphasia groups provide one avenue for continued practice with their speech and language goals, but this does not replace direct speech therapy with a speech-language pathologist. It’s amazing how the brain continues to change even years after its injury! I have seen people with aphasia 6+ years after their initial stroke who continue to improve in their speech and language skills once provided with direct speech therapy.
This topic is especially near and dear to my heart since my own father suffered a stroke at the age of 66. He lost the ability to use the right side of his body and had difficulties communicating due to a significant expressive aphasia as well as a motor speech disorder called apraxia of speech. This meant that he went from being fully trilingual in English, Japanese, and Korean, to only being able to speak one word at a time in his first language, Korean. Fortunately, he retained most of his ability to understand simple conversations and could still listen and laugh appropriately when our family was in conversation. With enough therapy and practice, he was able to speak short phrases and even order his own coffee all on his own whenever he did his laps at the local mall. What was interesting to me was watching others interact with him. Some people who knew him before his stroke continued to treat him the same and spoke to him as if he didn’t have a language impairment. Others sat awkwardly and did not know how to address my father. I saw my father light up when people took the time to engage with him but sit disinterested when people largely ignored him.
My hope is that with ongoing efforts like National Aphasia Awareness Month, people will realize that individuals with aphasia have a story to tell and that these individuals are just waiting for you to ask.
If you or a loved one is living with aphasia, please share this message.
Also, if you have questions about aphasia and speech therapy, call us at 289.856.9933 or email us at firstname.lastname@example.org.
Stay tuned for our next article that will review communication tips for those with aphasia.