Warren --

According to the speech/swallowing therapist presentation at the Hopkins HNC conference last week, you should meet with the therapist before (or early in) treatment, as well as with a nutritionist. At that time the therapist will just give you a head's up as to what the possible side effects can be, and how best to avoid them -- or if they cannot be avoided, as many cannot -- to ameliorate them. Thus the advice to start using the Therabite (or other jaw-stretching approaches) from the very beginning of treatment. The advice for swallowing is generally to try and continue swallowing as long as possible, even if only a bit of water or Boost, to keep the mechanism from atrophying. The nutritionist will help you here as well. You may get a gastric feeding tube (PEG) -- most centers strongly recommend these -- as it is vital to stay hydrated and also, to maintain adequate nutrition throughout treatment and in the recovery period. Some people never had to use their PEG, but most do, some almost 100%, others as a much-needed supplement to oral nutrition.

The swallowing test (a barium fluoroscopic evaluation) is usually done after the gross swelling and irritation from the radiation is going away, maybe 6-8 weeks' out, but this varies by center,

The therapist will, after consultation with the radiologist, design a series of exercises to improve muscle tone and swallowing ability. These may need to be continued indefinitely, by the way, as sometimes problems (scarring, fibrosis etc.) can "creep up" on you months or even years after the end of treatment.

Gail