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’t ignore.
“I loved to sing, and I realized that my voice wasn’t as high pitched as it used to be and was raspy, and my throat felt sore and dry all the time,” says David, who is 54. “I was too scared to face what it really was, so I put it off. I never thought anything would happen.”
But after a year and half, David’s 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.
“After my treatments, I started having pain in my throat and trouble swallowing,” he says. “I started feeling like something was blocking my airways.”
That’s when he contacted Rush for help.
Finding answers at Rush
David had an appointment with Kerstin Stenson, MD, 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.
“Ear pain is a giant red flag for patients with previous head and neck-related issues,” Stenson says. “That’s because the nerves that give sensation to your voice box and throat travel through the middle ear.”
Stenson ordered new scans, a biopsy and a laryngoscopy — a procedure to examine the throat and voice box.
The test results confirmed that David’s cancer had returned.
“The news was devastating,” he says, “especially after I had already gone through treatment at a previous hospital.”
Making a decision
David’s head and neck cancer team at Rush recommended a total laryngectomy — removal of the voice box — 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.
“By the end of the conversation, I couldn’t listen anymore,” he says. “That’s how hard it was at the time. I was very scared and afraid of what the outcome would be.”
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.
“It is never easy," she says, "but if you have to have a laryngectomy, it’s done to save your life.”
David went home and thought about what was best for him and his family.
“I locked myself in the bedroom and thought about whether it was worth going through. I thought about my kids, my wife, my future,” says the father of six, “and ultimately, I decided the right thing to do was to set up the surgery.”
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.
“We went over in much more detail with David how the surgery would affect his ability to speak, breathe and swallow,” Teitcher says. “And how we’d get him back to doing those things again.”
In December, Stenson performed the laryngectomy, removing David’s larynx and 24 lymph nodes. She also created a stoma — a permanent opening in the trachea — 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.
“I remember waking up in the hospital room and not being able to talk. I was moving my mouth, but I wasn’t hearing anything,” he says. “I realized in that moment that there was no turning back — it was a done deal. And then I started thinking, ‘Well, I have to figure out how I’m going to live like this now.’”
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.
“It may seem fast, but it’s a very powerful thing to immediately start taking ownership of all that there is to do with voice prosthesis,” Teitcher says. “We took small steps and slowly introduced new things to show him how he can care for himself — and that it’s not as scary as it looks.”
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.
“As the air moves up, it vibrates a muscle in the esophagus to produce a sound or the new voice, and they’re more often than not able to have a normal phrase length per breath. It allows for the most natural sounding speech,” he explains. “And to talk, they cover their stoma with a thumb to close it off — and they need to use a good amount of breath support to do that. And with time, they can gradually extend their speech length.”
David said adjusting to the prosthesis was hard at first.
“It was all overwhelming trying to talk again,” he says. “It took a while until I started figuring out how to use my voice and mixing it with enough air. But I kept telling myself, ‘I'm not going to stop trying.”
And after about a year — and with practice with Teitcher and his family — David found his new voice.
“It’s been a blessing to go from nothing to having a voice again. It might not sound the best, but it’s better than being fully mute,” David says. “And Josh has been the best in guiding me through it.”
Ongoing care
In January 2021, under the care of radiation oncologist Nikhil Joshi, MD, and medical oncologist Michael Jelinek, MD, 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 Obada Obaisi, MD, a physical medicine and rehabilitation specialist at Rush, to see if botulinum toxin injections — often used to relax tight muscles and relieve pain — could help with his neck stiffness after treatment.
“My whole team has been awesome,” David says. “They encouraged me to not give up. And I hug them every time I see them because I appreciate their care. If it wasn’t for them, I wouldn’t be here.”
“There’s nothing holding me back”
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.
“It’s been a blast, and I feel so much healthier,” David says. “Once 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’s nothing holding me back.”
Stenson admired David’s strength throughout treatment.
“He took the leap of faith for what had to be done to treat his cancer, and he ran with it,” she says. “He’s now modeling for others how to live a relatively normal life without a voice box.”
David says his biggest lesson learned — and his message to others — is to “take care of your health and don’t smoke.”
“Throat cancer doesn’t happen to everybody, but it does happen. And if you can put down that cigarette, you’re helping to prevent it,” he says. “If you want to smoke, that’s up to you — it’s your own life. But at least once a year, see your doctor. And if you have any signs, follow up with them. Don’t beat yourself up about it — and don’t wait around until something bad happens to do something about it.”
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’re ready to quit smoking, check out our Courage to Quit program.
