MY TOP RESOURCES

1. Macmillan
I am one of a growing number of allied health professionals whose post is funded by the cancer charity Macmillan. It wasnt until I was appointed that I appreciated how much support Macmillan provides to post holders, particularly in terms of training and equipment grants, which are a tremendous help when starting up a new post. The charity also funds speech and language therapy advisors on surgical voice restoration, which Ive found helpful when Ive needed assistance sorting out valve problems. Not to mention the advice and information leaflets, evidence updates and various courses and seminars. So, Macmillan has to be my number one resource. www.macmillan.org.uk

4. Communicaton systems
North Cumbria is a big geographical patch encompassing three primary care trusts and one acute trust which is on two hospital sites. Though Im hospital based, Im out and about two or three days a week doing outpatient clinics or on home visits, and its important that I can be contacted easily. We have an ansaphone in our office in the hospital, but I carry a pager as well and have a mobile phone for when Im travelling around the countryside. As Im a lone worker, the mobile phone also gives me a bit more security - and its a great help when Im lost on home visits and have to ring up for directions!

8. My patients
I am learning such a lot from the people I work with in this post. Being involved with palliative care patients has certainly encouraged me to be more holistic in my approach. Also, Im constantly impressed at how patients who have had extensive surgery do manage to learn compensatory strategies for swallowing, often with a great deal of perseverance and fortitude it has to be said. Some of the laryngectomees are very inventive and develop ingenious systems for managing valves and Heat and Moisture Exchangers which I would never have thought of.

Linda Slack is a Macmillan specialist speech and language therapist who works full-time with head and neck cancer patients and also those with palliative care needs. The post is a relatively new one which Linda has been developing since she was appointed almost two years ago. She is based in Carlisle and covers all of North Cumbria, which includes some of the Lake District, the West Cumbrian coast and up as far as the Scottish border. She works in both hospital and community settings and will often see patients from the point of diagnosis onwards.

5. Jeri Logemann
I was first inspired by Jeri Logemann when I attended one of the early courses she held in this country, at which time dysphagia was a new and growing area for speech and language therapists. Ive attended several other of her courses since then and continue to be impressed not only by her breadth of knowledge and experience, but also her continued enthusiasm and dedication. Her book Evaluation and Treatment of Swallowing Disorders (Pro Ed, 1997) continues to be an invaluable resource as are the many articles she has written on dysphagia in head and neck cancer over the years. http://www.advancedrehab.org/courses/ Swallowing/swallowing.html

9. Clinical support and supervision

At times I can feel professionally isolated and so I value the contact I have with speech and language therapy colleagues from the north east of England who also work with head and neck cancer patients. We meet up from time to time to offer one another clinical support as well as looking at service issues. I also have individual clinical supervision which helps me reflect on my practice and talk through any specific problems I might have. My clinical supervisor works in head and neck cancer but is not a speech and language therapist, which I find can encourage me look at things from a different perspective.

2. Videos
Providing training to other professionals is a key aspect of my job. This can range from teaching sessions to increase awareness of my role in the management of communication and swallowing problems in cancer patients, to specific training on the management of valves in laryngectomees. My video collection is invaluable in helping illustrate such things as normal and abnormal swallowing, communication problems and aspects of laryngectomy. Favourites are Swallowing Matters (for the normal swallow sequence in particular), Dysphasia Matters, Talking it Through, and Nursing and Laryngectomee Care (some of which was filmed in our hospital). Dysphasia Matters (video alone 45, as part of complete training package 105) from Speakability, 1 Royal St, London SE1 7LL, tel. 020 7261 9572. Talking It Through / Nursing and Laryngectomee Care both from the National Association of Laryngecomy Clubs (NALC), tel. 0207 381 9993. Swallowing Matters from MNDA of Victoria, P.O.Box 23, 265 Canterbury Rd, Canterbury, Victoria, Australia, http://www.mnd.asn.au/information. html#Videos.

10. Multidisciplinary team clinic

The head and neck cancer team has a weekly clinic in which new patients are seen and others reviewed. Whilst the number of professionals present during patient consultations concerns me at times, being present to hear exactly what the doctors say has many advantages. It means that I can subsequently check out a patients understanding of what has been said, reinforce information and clarify any misunderstandings. The multidisciplinary team discussion - which takes place before each consultation - is invaluable as it provides me with information on diagnosis and treatment as well as an opportunity to address issues relating to communication or swallowing.

6. Diagrams and models

Providing information and explanation pre-operatively to patients and their relatives is a key aspect of my job. Its important that patients are prepared for the potential effects of surgery on communication and swallowing so that they are well informed when making decisions about their care. I use diagrams and models when explaining the anatomy and effects of surgery and patients seem to find them helpful. The Before and After Laryngectomy diagrams produced by In Health are very useful, particularly the tear off pads so patients can take copies home (from Forth Medical Ltd, tel. 01635 550100). I also like some of the models produced by Adam Rouilly (tel. 01795 471378), particularly the median section of the nose, mouth and throat which has a movable epiglottis - useful when explaining swallowing.

3. Books
I feel as if Ive been on a steep learning curve since starting this job and have needed to do lots of reading. The palliative care component has meant that Ive worked with patients who have had cancers which I had little experience of, such as lung and oesophageal cancers, and lymphomas. Two additions to my library which Ive found very helpful are Cancer and its Management by Robert Souhami & Jeffrey Tobias (Blackwell Science, 2002) and Swallowing and Communication Intervention in Oncology by Paula Sullivan & Arthur Guilford (Singular, 1998), which includes useful chapters on chemotherapy and radiotherapy as well as the impact of different cancer sites on swallowing. Another useful introductory book has been Supportive and Palliative Care in Cancer by Claud Regnard & Margaret Kindlen (Radcliffe Medical Press, 2002).

7. My tool box
This carries my tool kit for sorting out laryngectomees valve and stoma problems and it stays in the boot of my car for when Im on home visits. Its also useful when I do practical teaching sessions, such as for district nurses. Its a hobby box (mine was bought from a local Wilkinsons shop) which has lots of compartments for valves, Heat and Moisture Exchange systems, tape, brushes, catheters and all the other odds and ends I regularly use. Our head and neck ward now supply all new laryngectomees with similar boxes so that they have somewhere to keep all the items they are sent home with.

It wasnt until I was appointed that I appreciated how much support Macmillan provides to post holders, particularly in terms of training and equipment grants, which are a tremendous help when starting up a new post.