David Ramirez smoked his first cigarette when he was just 15. For nearly 40 years, smoking was part of his daily life, even as his family encouraged him to quit.
But in 2018, changes in his voice hinted at a deeper problem he couldn鈥檛 ignore.
鈥淚 loved to sing, and I realized that my voice wasn鈥檛 as high pitched as it used to be and was raspy, and my throat felt sore and dry all the time,鈥 says David, who is 54. 鈥淚 was too scared to face what it really was, so I put it off. I never thought anything would happen.鈥
But after a year and half, David鈥檚 hoarseness worsened, so he made an appointment at a local hospital. Tests later revealed tumors on his vocal cords, and in October 2019, a biopsy confirmed it was laryngeal cancer.
So he quit smoking, and in December 2019, he underwent surgery to remove the tumors, followed by radiation, which ended in January 2020. But something was still off.
鈥淎fter my treatments, I started having pain in my throat and trouble swallowing,鈥 he says. 鈥淚 started feeling like something was blocking my airways.鈥
That鈥檚 when he contacted Rush for help.
Finding answers at Rush
David had an appointment with , a head and neck surgeon at Rush, who helped manage his pain. But by October, the pain had only worsened in his throat, chest and even his ears.
鈥淓ar pain is a giant red flag for patients with previous head and neck-related issues,鈥 Stenson says. 鈥淭hat鈥檚 because the nerves that give sensation to your voice box and throat travel through the middle ear.鈥
Stenson ordered new scans, a biopsy and a laryngoscopy 鈥 a procedure to examine the throat and voice box.
The test results confirmed that David鈥檚 cancer had returned.
鈥淭he news was devastating,鈥 he says, 鈥渆specially after I had already gone through treatment at a previous hospital.鈥
Making a decision
David鈥檚 head and neck cancer team at Rush recommended a total laryngectomy 鈥 removal of the voice box 鈥 followed by a voice prosthetic implant and rehabilitation to help restore his ability to speak.
They walked him through each step of his care plan, but for David, it was a lot to take in.
鈥淏y the end of the conversation, I couldn鈥檛 listen anymore,鈥 he says. 鈥淭hat鈥檚 how hard it was at the time. I was very scared and afraid of what the outcome would be.鈥
For anyone facing a laryngectomy, accepting a permanent opening in the throat and changes in their ability to speak can be overwhelming to process, Stenson says.
鈥淚t is never easy," she says, "but if you have to have a laryngectomy, it鈥檚 done to save your life.鈥
David went home and thought about what was best for him and his family.
鈥淚 locked myself in the bedroom and thought about whether it was worth going through. I thought about my kids, my wife, my future,鈥 says the father of six, 鈥渁nd ultimately, I decided the right thing to do was to set up the surgery.鈥
A voice box removal
A week later, David met with Stenson and Josh Teitcher, a speech pathologist at Rush, to review the procedure again and what to expect.
鈥淲e went over in much more detail with David how the surgery would affect his ability to speak, breathe and swallow,鈥 Teitcher says. 鈥淎nd how we鈥檇 get him back to doing those things again.鈥
In December, Stenson performed the laryngectomy, removing David鈥檚 larynx and 24 lymph nodes. She also created a stoma 鈥 a permanent opening in the trachea 鈥 to help him breathe and implanted a small, valve like voice prosthesis that would help with speech.
The surgery went as planned, but now David would have to adapt to life without his natural voice.
鈥淚 remember waking up in the hospital room and not being able to talk. I was moving my mouth, but I wasn鈥檛 hearing anything,鈥 he says. 鈥淚 realized in that moment that there was no turning back 鈥 it was a done deal. And then I started thinking, 鈥榃ell, I have to figure out how I鈥檓 going to live like this now.鈥欌
Learning how to talk again
The day after the surgery, Teitcher began working with David to help manage his life with a neck stoma and how to use the voice prosthesis.
鈥淚t may seem fast, but it鈥檚 a very powerful thing to immediately start taking ownership of all that there is to do with voice prosthesis,鈥 Teitcher says. 鈥淲e took small steps and slowly introduced new things to show him how he can care for himself 鈥 and that it鈥檚 not as scary as it looks.鈥
The voice prosthesis works by creating an opening between the trachea and esophagus, allowing a person to send air through the prosthesis into the esophagus, Teitcher says.
鈥淎s the air moves up, it vibrates a muscle in the esophagus to produce a sound or the new voice, and they鈥檙e more often than not able to have a normal phrase length per breath. It allows for the most natural sounding speech,鈥 he explains. 鈥淎nd to talk, they cover their stoma with a thumb to close it off 鈥 and they need to use a good amount of breath support to do that. And with time, they can gradually extend their speech length.鈥
David said adjusting to the prosthesis was hard at first.
鈥淚t was all overwhelming trying to talk again,鈥 he says. 鈥淚t took a while until I started figuring out how to use my voice and mixing it with enough air. But I kept telling myself, 鈥業'm not going to stop trying.鈥
And after about a year 鈥 and with practice with Teitcher and his family 鈥 David found his new voice.
鈥淚t鈥檚 been a blessing to go from nothing to having a voice again. It might not sound the best, but it鈥檚 better than being fully mute,鈥 David says. 鈥淎nd Josh has been the best in guiding me through it.鈥
Ongoing care
In January 2021, under the care of radiation oncologist , and medical oncologist , at Rush, David underwent six weeks of radiation and four rounds of chemotherapy to reduce the risk of a recurrence. And soon David was able to start using a hands-free device that allows him to speak through the prosthesis without using his thumb.
More than four years later, David has had no evidence of cancer.
David now sees Stenson and his cancer team every six months to check his swallowing, breathing and stoma, and has a yearly CT scan. He also visits Teitcher every 10 months to replace his prosthesis. And he saw , a physical medicine and rehabilitation specialist at Rush, to see if botulinum toxin injections 鈥 often used to relax tight muscles and relieve pain 鈥 could help with his neck stiffness after treatment.
鈥淢y whole team has been awesome,鈥 David says. 鈥淭hey encouraged me to not give up. And I hug them every time I see them because I appreciate their care. If it wasn鈥檛 for them, I wouldn鈥檛 be here.鈥
鈥淭here鈥檚 nothing holding me back鈥
Since treatment, David has enjoyed birthdays and holidays without limitations and has even become a grandfather to three more kids. He has also served as a guest lecturer with Teitcher, helping to teach future speech pathology students at Rush about laryngectomy care.
鈥淚t鈥檚 been a blast, and I feel so much healthier,鈥 David says. 鈥淥nce I figured out how to adjust a bit, I went back to living my life without any issues. And I even learned to whistle! There鈥檚 nothing holding me back.鈥
Stenson admired David鈥檚 strength throughout treatment.
鈥淗e took the leap of faith for what had to be done to treat his cancer, and he ran with it,鈥 she says. 鈥淗e鈥檚 now modeling for others how to live a relatively normal life without a voice box.鈥
David says his biggest lesson learned 鈥 and his message to others 鈥 is to 鈥渢ake care of your health and don鈥檛 smoke.鈥
鈥淭hroat cancer doesn鈥檛 happen to everybody, but it does happen. And if you can put down that cigarette, you鈥檙e helping to prevent it,鈥 he says. 鈥淚f you want to smoke, that鈥檚 up to you 鈥 it鈥檚 your own life. But at least once a year, see your doctor. And if you have any signs, follow up with them. Don鈥檛 beat yourself up about it 鈥 and don鈥檛 wait around until something bad happens to do something about it.鈥
For information on head and neck cancer care at RUSH MD Anderson Cancer Center, visit us online or call (312) CANCER-1. And if you鈥檙e ready to quit smoking, check out our Courage to Quit program.
