After reading several articles regarding depression and coping with life after a total laryngectomy, I thought that I would open a discussion regarding my younger brother (he is 53). He was

diagnosed in 2009 with cancer of the larynx and after a very heavy course of radiotherapy, was told that the treatment had been successful and that he was cancer free. This was great news as my brother has suffered from manic depression and under heavy medication for many years and the news of his cancer and consequent treatment only exasperated this condition.  Unfortunately, the scar tissue that formed, grew to such an extent that it was necessary for him to undergo an emergency tracheostomy to enable hime to breathe (this was approximately six months after the radiotherapy) Things then started to improve, he was feeding through a rig in his stomach and getting stronger. The tracheostomy tube was eventually removed and we all thought that things were going to be ok.  He then started to complain of breathing difficulties again and after further examinations, it was found that the cancer had returned and that the only option to get rid of it would be to have a total laryngectomy. The operation did not go too well and it was necessary for him to have his chest pectoral major muscle grafted to try and repair several large fistulas which would not heal. This was a pretty gruesome operation which involved a lengthy hospital stay and several months of home care with dressings etc as the wound would not heal. Eventually it did heal but once again, scar tissue started to close his throat which made him unable to even swallow his saliva or any food and drink. Laser treatment was the discussed and this was carried out. The scar tissue grew back again and this time the consultant decided that more radical surgery was needed if there was to be any chance of him ever being able to eat/swallow in any way. We were advised that a jejunam graft/transfer (part of the bowel) would be used to give him a new esophagus. Once again, this was not successful and after a thirteen hour surgery, a forearm tissue graft was used to reform the damaged/removed esopagus. Another lengthy hospital stay and recovery ensued and this has now brought us up to date. The procedure seems to have been a success as he is now once more eating foft foods and liquids but still has problems swallowing and has no speech. The speech valve catheter that was initially fitted after his first operation became dislodged and it was decided that another one would not be placed until the results of the final surgery were confirmed. He has just had an insufflation test which was semi successful and has now been told that a speech valve is a distinct possibility of him being able to improve communication. After a lengthy chat at the speech and language clinic last week, he has now gone back into a deep depression and feels that there are too many complications regarding the upkeep of his speech valve and that he has decided that perhaps it is better that he does not go ahead with it. Is there anyone who has gone through the same sort of procedures and complications (multi grafts and fistulas and MRSA) that could perhaps give me some sort of insight and what I could do do try and encourage him now he has gone through so much, it would be great to try and give hime some hope. I am now his main carer and as well as his sister and he worries me so much. Thanks for taking the time to read my rather long opening discussion, but there was so much to write. I hope that someone can advise me.