May 21, 2018 | May 21, 2018 | There were plenty of reasons why Seth Mohorn would need a feeding tube for an extended period after a recent surgery, but he was determined to quell them.
It did not matter that an everyday task would suddenly require more effort from him than ever before. He wanted to continue to eat and drink as he always had.
Mohorn, 46, of Springdale, has medullary thyroid cancer.
“This is a rare form of thyroid cancer that is very aggressive,” said Mauricio Moreno, M.D., head and neck surgeon and assistant professor in the UAMS College of Medicine‘s Department of Otolaryngology. “It originates from the thyroid like other forms, but its treatment is not the same.”
Chemotherapy, radiation and surgery have all been part of Mohorn’s treatment. His most recent procedure in 2016 was the most extensive. Multiple tumors reappeared in Mohorn’s neck, including one at the base of his skull.
To reach it, Moreno had to cut through layers of muscle and nerves, as well as Mohorn’s jaw bone. The incision started under Mohorn’s ear, extended to the middle of his neck and up through the middle of the jaw. Moreno dissected muscles and nerves in the area to lift the bone and access the tumor.
Mohorn left the hospital with a feeding tube. At his first post-operative visit two weeks later, he was ready for its removal.
Amanda Davis, UAMS Speech Pathology Program manager and Mohorn’s speech pathologist, explained to him the long-term swallowing issues he would have as result of his surgery.
Ordinarily, the throat squeezes to push the food down into the stomach. The airway briefly closes to ensure no food falls through and into the lungs. Mohorn’s would not, Davis said, because many of the muscles that complete those tasks were involved in his surgery. He would have swallowing issues and be at risk of aspirating food into his airway, said Davis.
The result of a thyroidectomy in 2014, also done by Moreno, would also provide a stumbling block. The surgery included the removal of one tumor that encompassed Mohorn’s left vocal cord. That left his vocal cord paralyzed.
“The vocal cords are a protection,” said Davis. “If food gets in the airway, they will close off and induce a cough. With a paralyzed vocal cord, Seth would not be able to do this.”
After the type of surgery Mohorn endured, Moreno said it is common for his patients to be on a feeding tube for an extended period of time.
“The speech and swallowing impediments are pretty significant and we see it immediately after the procedure,” said Moreno. “The patient wants to be able to eat normally and swallow, but they just cannot because so many nerves and muscles are involved with that procedure.”
Davis recommended Mohorn move forward with a feeding tube while he recovered from surgery; however, Mohorn was adamant he could do without the tube with the support of his family and friends.
“We had a conversation about his wishes and he did not want a tube,” said Davis. “We struck a deal and told him to try it for two weeks and come back to see us.”
If he came back with other issues or significant weight loss, he would have to have a feeding tube inserted.
Davis walked Mohorn through the steps he would need to take. To start off, his food would need to be blended and his liquids thickened to the consistency of honey. Every bite would need to be consumed in teaspoon sizes alternating between food and drink each time.
To properly digest his food, Mohorn tucked his chin and swallowed three, four and five times for each bite. He was taught certain techniques to make sure his throat was clear. One was the supraglottic swallow. It required him to swallow, hold his breath, cough and swallow again.
“When we swallow, the airway closes so food can pass, but without proper control, you start breathing again,” said Davis. “If food or liquid is still there, it is likely to go in your airway, so this method acts as a precaution in case something does pass into the airway.”
At his first follow-up visit, he was progressing well, said Davis.
Davis recommended exercises Mohorn could complete at home to strengthen his muscles. With each return visit, he was better. Slowly, modifications were made to return him to a normal diet.
“The last time I saw him I walked in and he was eating a bag of chips,” said Davis. “I said, ‘I think you’re fine.’”
Moreno and Davis said they were both impressed by Mohorn’s drive.
“He was one of those patients with specific goals and willing to do what it took to get there,” said Davis.
“He’s a go-getter,” said Moreno.
Mohorn was thankful to be part the decision-making process in his treatment.
“Amanda was the greatest advocate,” said Mohorn. “She knew me far beyond what the folder said about me. She went and fought on my behalf to give me a chance.”
Mohorn was recognized by the Arkansas Speech-Language-Hearing Association in 2017 as its Adult Poster Ambassador. In his acceptance speech, he challenged the room full of audiologists and speech pathologists to be an advocate for their patients and develop relationships with them.
“Know their needs and know their characteristics and qualities,” said Mohorn. “In doing so, you push them to greater heights.”
He acknowledged that his cancer has put him “in the fourth quarter of life.” But Mohorn said he refuses to be driven by fear or anger. He said he’s learned to be content in the year since his cancer diagnosis. He is focused on his family and advocating for change.