Discussion | 251 11 possibly due to sarcopenia, could also affect exercise capacity, highlighting the need for tailored CPET protocols for laryngectomy patients. The current protocol may not be suitable for using CPET as a baseline for exercise rehabilitation, especially for patients who underwent laryngectomy a significant time ago. Conducting spirometry prior to a CPET could improve gas analysis interpretation, particularly since many laryngectomy patients are (former) smokers and may have COPD, which could influence test outcomes. A submaximal exercise test, such as the six-minute walk test, would be more appropriate. If this test shows that a patient can tolerate maximum exertion, then a CPET could be feasible. However, I would advocate for a progressive exercise plan based on the six-minute walk test, as walking is beneficial for nearly everyone, making it a practical and achievable activity that could lead to more realistic rehabilitation goals and meaningful results. Chapter 10 beholds a letter to the editor. This letter underscores the unique case of a former patient, whose journey of resuming singing after total laryngectomy sheds light on the therapeutic potential of music for patients undergoing similar procedures. By sharing his story and the challenges he faces, such as managing air pressure and song selection, the letter emphasizes the importance of exploring creative avenues for rehabilitation beyond traditional methods. Furthermore, it references existing research and initiatives, including choirs for laryngectomees and therapeutic singing programs, which suggest that singing can offer not only physical benefits but also psychological ones, such as improved mood and self-confidence. Encouraging laryngectomy patients to embrace singing as part of their recovery journey not only promotes holistic healing but also empowers them to explore their full potential beyond the confines of their medical condition. Healthcare professionals can play an active role in this by setting up these programs. This is a very proactive patient, but how do we engage those who are less extroverted? This is a crucial aspect of rehabilitation. Besides singing, other activities might also be beneficial, such as swimming with a ‘Larkel’32. Engaging in hobbies or activities that make individuals feel valuable again can be a potent component of rehabilitation. This approach not only helps patients recover physically but also rebuilds their sense of self-worth and community involvement.
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