|Name Of Column
||Scrunch Your Toes!
||Gregory P Reece, MD
||Intraluminal Stoma Button
||Life is Good
|This Lary Life
||Grands are Great
|Travel with Larys
||Travel & Photos
||Len A Hynds
||The Colours We See
|Bits, Bytes & No Butts!
INDEX AND LINKS TO EACH ISSUE MAY BE FOUND AT: http://webwhispers.org/news/WotWIndex.asp
Scrunch Your Toes!
Something new to me and so simple that anyone can find a time and place for it.
I have had some aches and pains in my old bones or the muscles that hold them together. Not enough for medication but enough to interfere with my bike riding and I KNOW I get off of the bike walking straighter and more free moving. My feet have been .... not painful, but not comfortable by a long shot. Two days ago, I was given an exercise (Yeah! I know how long that usually lasts.) Today, for the third day, I sat down at the computer with shoes off and feet on a small towel on the floor that I have used for two days and proceeded to do the following exercise, Toe Scrunch.
To strengthen your feet. The idea being that the stronger the base you stand on, the better your body performs. This uses muscles you didn't even know you had, but ones that help keep the feet healthy.
Towel Scrunch: Sit on a chair and place your bare feet on a towel. Draw the towel in toward your heels by scrunching your toes. Then stretch your toes up and curl again as you come down. Do this ten times with each foot.
Here are a couple of quick videos of what I have been told to do... scrunch the towel while sitting or standing.
Do a little special walking barefoot on carpet, remember, be conscious of each step. Start with the heel and roll toward the toes, and scrunch as they come down..Try down the hallway and back or across the room.Or stand up in front of the TV while you watch your favorite show:
One foot at a time. Keep your heel on the ground, scrunch your toes and lift the sole of your foot, then, flex and spread the toes while pressing the ball of your foot into the ground. Repeat or alternate with other foot. 5 minutes.
Do one or all of these. My third day and the circulation is better in my feet. Try it. Feel it!
BTW, you might finish with a rubber or tennis ball under your foot and roll it around for your own foot massage.
Improving retention of an intraluminal stoma button
for hands-free tracheoesophageal speech
Gregory P. Reece, MD
Department of Plastic Surgery,
The University of Texas M. D. Anderson Cancer Center,
Tracheoesophageal (TE) voice restoration has become a common choice for vocal rehabilitation in patients who have undergone a total laryngectomy since it provides voice quality and fluency that are comparable to normal laryngeal speech. TE speech is achieved using a unidirectional valve that diverts expiratory airflow towards the pharyngoesophagus and, at the same time, protects the airway during swallowing. To speak, the patient must occlude the tracheostoma with their thumb or use an intraluminal stoma button that has an adequate attachment for a hands-free speaking valve. Although digital occlusion of the stoma is the easiest method for performing TE speech, most patients consider it socially unacceptable for hygienic reasons.
For any intraluminal stoma button to function as an adequate attachment for a hands-free speaking valve, the tracheostoma must meet several anatomic criteria. First, the stoma must have a relatively circular shape with an adequate mucocutaneous scar around the entire perimeter to support the button and provide a snug fit of the button’s shaft to prevent air leakage and dislodgement during TE speech. Second, the TE puncture must be located at least 10-15 mm below the mucocutaneous scar to avoid blockage of the puncture site by the button’s shaft. Third, the soft tissues around the stoma must be flat for adequate retention of the device. Finally, the stoma must be located in a superficial plane (i.e., at the level of the surrounding skin), leaving enough space for the external part of the button, which has a greater diameter than the shaft, to avoid contact with other structures.
Although intraluminal buttons can be customized to improve fit in patients with minor tracheostomal deformities, patients with multiple or severe stomal deformities are often unable to use a customized button for retention of the hands-free speaking valve. To improve the quality of life of the laryngectomy patient with a deformed and inadequate tracheostoma, a single-stage, minimally invasive technique, termed a “tracheostomaplasty,” was developed to revise the existing stoma to provide a permanent perennial retention surface for an intraluminal stoma button.
The main objectives for developing this surgical procedure were: 1) to create a new stoma (neostoma) utilizing the peristomal skin but without revising the mucocutaneous scar; 2) to create a neostoma with a diameter that meets the airway demands of most individuals; 3) to utilize fascial grafts from the patient to provide long-term support for the neostoma; 4) to avoid unnecessary manipulation of the peristomal soft tissues by using minimally invasive techniques; and 5) to limit the use of local skin flaps to cases in which they are strictly necessary.
A BRIEF DESCRIPTION OF TRACHEOSTOMAPLASTY
All patients undergoing a tracheostomaplasty receive intravenous antibiotics in the holding room prior to arriving in the operating room. The patient is placed on the operating table in a supine position and general anesthesia is induced through a size 6 reinforced endotracheal tube placed in the tracheostomy. Then, the patient’s neck, chest, and one thigh are prepared with an antimicrobial solution and draped in a sterile fashion.
The first step of the tracheostomaplasty is to harvest a tensor fascia lata (TFL) graft from the thigh donor site. A 4-cm-long incision is made over the distal lateral thigh parallel to the axis of the limb and carried down to the TFL fascial tendon. A 1-cm-wide flap of the fascia is incised and a Crawford fascial stripper is used to remove a total length of fascia about 13–15 cm. The graft is defatted, wrapped in a sterile saline-soaked sponge, and placed on a Mayo stand for later use. Pressure is used to obtain hemostasis, and the TFL-donor site is closed and sterile dressings applied.
A subcutaneous tunnel located approximately 1 cm from the edge of the stoma of the tracheostomy is created through 1-cm radial incisions at the 3, 6, and 9 o'clock positions around the stoma (Figure 1). The skin is incised, and a Jacobson hemostat is used to bluntly dissect a subcutaneous tunnel circumferentially around the stoma from one incision to the next. The TFL graft is then pulled through the subcutaneous tunnel such that both ends of the graft enter and exit through the same incision. The ends of the graft are held with a hemostat and a small slit is made in one end of the graft and the other end of the graft is pulled through the slit (Figure 2).
Next, the endotracheal balloon is briefly deflated, a size 12 short intraluminal button (outer diameter: 17 mm) is placed over the end of the endotracheal tube, and the balloon is returned to the airway and reinflated. The shaft of the button is used as a guide to set the diameter of the stoma. This is done by pulling the ends of the tendon graft in opposite directions and cinching the stomal skin in a purse-string fashion. The ends of the graft near the slit are sutured together and the excess tendon is then cut from the ends of the graft. The wounds are irrigated copiously throughout the procedure with an antibiotic saline irrigation fluid. A small round drain is placed in the subcutaneous tunnel circumferentially and allowed to exit from a site several centimeters from the stoma.
The radial incisions are each closed and then the patient is extubated (Figure 3). A size 8 (outer diameter: 12 mm) Provox LaryTube (Atos Medical) is placed to protect the airway, and the patient is taken to recovery for overnight observation. Once the airway is stable and patent, the LaryTube is removed the following day. To allow adequate wound healing and to avoid stomal dilation, patients are instructed to avoid digital occlusion of the stoma or placement of a stoma button in the neostoma for 3 weeks after surgery.
RESULTS OF TRACHEOSTOMAPLASTY
Approximately 23 patients have undergone a tracheostomaplasty since the surgical procedure was first developed. Most of these patients had received radiation therapy some time prior to the procedure. The absence of a circumferential stomal mucocutaneous scar, alone or in addition to other deformities, was an indication for the procedure in all cases.
To achieve a stoma suitable for hands-free TE speech, other procedures—in addition to tracheostomaplasty—were performed as indicated. Although revision of the neostoma is unusual now, the most common reason for revision was that the neostoma dilated to the point that a snug fit of the customized stoma button could not be achieved. Approximately 80% of those requiring a revision were ultimately able to wear the intraluminal button. Exposure to radiation therapy did not have a significant association with the necessity for revision procedures
The most common complication associated with tracheostomaplasty is a peristomal cellulitis. However, the routine use of the small drain has drastically reduced this complication. Delayed complications are rare and include stoma dilation, recurrent deformity of the stoma with air leakage, and stomal stenosis.
Most of the patients (about 90%) who have undergone tracheostomaplasty are able to successfully wear a stoma button for TE speech. Of the few patients who are unable to achieve hands-free TE speech, all achieved good TE speech with digital occlusion of the button and tolerated wearing the button for 6 or more hours. Roughly 56% of the patients who underwent tracheostomaplasty achieved hands-free speech.
LIMITATIONS OF TRACHEOSTOMAPLASTY
Among the different techniques for hands-free TE speech, use of an intraluminal stoma button has the advantage of self-retention, which avoids the difficulties of peristomal attachment with adhesives. Obtaining an airtight seal around the stoma with peristomal attachments can be difficult. Unfortunately, the specific stomal morphology that is required for a snug fit of an intraluminal stoma button is not always achievable after total laryngectomy. Regardless of the stomal construction technique, few tracheostomas are circular, and it is very difficult to predict the formation of a prominent circumferential scar around the stomal edge. For this reason, the reported success of these intraluminal devices ranges from 25% to 66% in different series. Attempts to modify the intraluminal button for a snug fit have had some success, even in the presence of an inadequate stomal morphology. However, a technique to surgically restore the stomal morphology was needed for some patients with complex stomal morphology.
Tracheostomaplasty is able to create a round fixed stoma for most patients that have a deformed tracheostoma. However, this method is limited in some patients, especially those patients that have very poor skin quality due to severe radiation changes or that have a funnel-shaped retrosternal stoma. Patients with these problems need to have additional tissue added to replace the irradiated skin or to move the stoma superiorly away from the sternum, respectively. Tracheostomaplasty will also have limited success at retaining the intraluminal button for patients that generate high intraluminal airway pressures or that have excessive pharyngoesophageal ballooning when they speak.
Overall, tracheostomaplasty provides a practical surgical alternative for improving the retention of an intraluminal stoma button, facilitating the attachment of speaking valves for hands-free TE speech. This standardized, minimally invasive technique is associated with few major complications and achieves a high success rate, even in patients with previous radiation exposure and complex stomal deformities. Cooperation between speech pathologists, head and neck surgeons, and plastic surgeons is of paramount importance to achieve successful speech rehabilitation in these patients.
Intraoperative photograph of the original tracheal stoma with 1-cm markings at the 3, 6, and 9 o’clock positions.
Intraoperative photograph of the tensor fascia lata graft placed in a purse-string fashion around the tracheal stoma. Note that one end of the graft is going through a slit in the other end of the graft.
Intraoperative photograph demonstrating an intraluminal button in the stoma. All incisions have been closed.
DeSanto LW, Olsen KD, Perry WC, Rohe DE, Keith RL. Quality of life after surgical treatment of cancer of the larynx. Ann Otol Rhinol Laryngol 1995;104(10 Pt 1):763-769.
Singer MI. Tracheoesophageal speech: vocal rehabilitation after total laryngectomy. Laryngoscope 1983;93(11 Pt 1):1454-1465.
Williams SE, Scanio TS, Ritterman SI. Perceptual characteristics of tracheoesophageal voice produced using four prosthetic/occlusion combinations. Laryngoscope 1990;100(3):290-293.
Ten Hallers EJ, Marres HA, Rakhorst G, et al. Difficulties in the fixation of prostheses for voice rehabilitation after laryngectomy. Acta Otolaryngol 2005;125(8):804-813.
Barton D, DeSanto L, Pearson BW, Keith R. An endostomal tracheostomy tube for leak-proof retention of the Blom-Singer stomal valve. Otolaryngol Head Neck Surg 1988; 99(1): 38-41.
Lewin JS, Lemon J, Bishop-Leone J K, et al. Experience with Barton button and peristomal breathing valve attachments for hands-free tracheoesophageal speech. Head Neck 2000; 22(2): 142-148.
Lemon JC, Lewin JS, Chambers MS, Martin JW. Modification of the Barton button for tracheoesophageal speech: an innovative maxillofacial prosthetic technique. J Prosthet Dent 2002; 87(2): 236-239.
Blom ED, Hamaker RC. Tracheoesophageal voice restoration following total laryngectomy. In: SJ Myers, editor. Cancer of the head and neck. New York: Saunders; 1996. p 839–851.
Moreno MA, Lewin JS, Bishop Leone JK, Barringer DA, Reece G. Tracheostomaplasty: A Surgical Method for Improving Retention of an Intraluminal Stoma Button for Hands-Free Tracheoesophageal Speech. Head & Neck: Journal for The Sciences & Specialties of The Head and Neck 32(12):1674-80, 12/2010.
Reece G. Stomaplasty for Hands-Free Voice with Tracheoesophageal Puncture. In: Atlas of Head and Neck Surgery. Ed(s) Cohen JI, Clayman GL. Elsevier Saunders: New York, 373-382, 2011.
Life is Good
As I reviewed this month’s edition before it was published I was so pleased with all the photos and comments that our readers have contributed. It adds so much to each issue.
I like it when we can put a name to a face, so I have especially enjoyed seeing the photos you have sent in for This Lary Life. For those of you not sure about to how to send your photos via e-mail, Frank Klett’s new column, Bits, Bytes and No Butts, tells you how this month. See the column at the bottom of the page.
Jack Henslee’s column, Speaking Out, has been a huge success. It gives us a chance to hear from folks who may not be regular writers in to the daily list. And Jack’s travel columns are always a treat…plus even more pictures!
Speaking Out’s question this month is,”What are you most thankful for?” and since This Lary Life is about grandchildren, the folks who sent in photos for This Lary Life also commented about how thankful they were to be able to be a part of their grandchildren’s lives.
This Lary Life has covered travel and grandchildren so far. But of course, not everyone has something to share on those subjects. As I was trying to think of other possibilities where folks might have taken pictures I remembered a column written back in 2006 that generated a surprising number of responses. At the time there had been some chatter on the list about whether larys could or should have pets. I don’t remember now the exact story but apparently someone had been told by his doctor that it was not advised and he was wondering whether he really had to give up the family pet. The answer is no but a lot of folks wrote in to say they wondered the same thing. My column was about my two new kittens and what joy they brought to my life. And I have taken lots of pictures of them over the years, some even with grandchildren; although none that involve grandkids, cats and travel (the cats get carsick).
So December is for all you animal lovers out there. Send us a picture of your favorite furry or feathered or scaly…or whatever friend. If you have a story to go with it, all the better. Marlene may have to re-tell the story about her miracle tornado kitty. But I am sure there are many others . You can send them to us at firstname.lastname@example.org
And if animals aren’t your thing, let us know what you do have pictures of you’d like to share. We are open to suggestions. It’s all good.
Mohan Raj, Bangalore - Mar 2010
Q: "What thing or things are you most thankful for?"
A: The next breath.
Terry Duga, Indianapolis, Ind - 1995
The most obvious is being alive and in relatively good shape.
While the operation was tough, it beat the alternative.
Len A.Hynds, Ashford Kent, England - June 2004
The last of those three cancer operations had been a close run thing, lasting many hours, and, although unconscious, my subconscious spirit was aware of the desperate battle to keep me alive by those dedicated doctors, technicians and nurses. Then many hours in intensive recovery and then, at las,t being returned to my room, in the Rotary Ward of my hospital.
This poem is of the true awakening, and the first person who greeted me back to the land of the living.
It was Nursing Sister Barbara ( Babs) Wagstaff.
By Len A.Hynds
In that dream-like state, twixt life and death,
I had pondered my fate, as I fought for breath.
My life passed before me, as the doctors they tried,
to kill all the cancer, with nowhere to hide.
Such skills they had, as they saved my life,
such joy they caused to my poor suffering wife.
No more to hear, " Goodbye dear old friend,"
as back to my room. to Rotary to mend.
I knew that angels had been so near,
singing so softly to banish my fear.
Some then followed me back to my room,
now faces familiar in the vanishing gloom.
As I opened my eyes, feeling so weak,
wired and tubed, and unable to speak,
an angel spoke," Hello my sweetheart,
this is the first day, that your new life will start."
That angel was Babs, our own Sister Wagstaff,
that nurse who can make just any-one laugh.
Such genuine kindness is hard to find,
love for her patients, is what comes to mind.
So thank-you Babs, for just being there,
thank-you for your nursing care.
Thank-you for, 'Hello sweetheart.'
Thanks to the team of which you are part.
Flossie Hopkins - Caregiver since Sept 25 2010
Thankful he is still here, still on tube feed, has lesion in stent, not healing due to radiation 25 yrs ago. No liquid. All meds in tube, got knocked down with lymph problems. Had to get chemo and now he is on meds for neuropathy, nerve ending pain from chemo. Accepts it. He has great faith. Now, we will see surgeon to make stoma larger in Nov. Healthy. Hair coming back better cuts grass does what he can he can eat treat pasts mashed Potatoes, etc. Jevity is his main diet.
God has been good to us. And we get to say HAPPY ANNIVERSARY to each other on the 8th of Oct, 52 years. Past 2 anniversaries were spent in hospital. We are in Ocean View, DE and go to Tunnell Cancer Center.
Have a great day to all.
Dave Ross, FL - 2005
Jack indicated he was most interested in our post-op but the outstanding things that I am truly most grateful for are equally inclusive of my pre and post operative experiences.
1) Web Whispers
2) My surgeon and SLP
Plain and simple!
Tom Olsavicky, VA -
For me there are so many things to be thankful for. First, was the Tidewater Lost Chord Club in Va. Beach whose members gave me the confidence that I desperately needed to go through with the operation. I didn't want to have my voice box removed and face the unknown future without a voice. They showed me that I would in fact speak again and I could lead a productive life after surgery. Second, was the skilled hands of my surgeon, Dr. Wadsworth, whose experience in performing the operation, removed the cancer, gave me a trouble free stoma, and my own choice of how I would communicate from that point on.
Third, I am very thankful for having a registered nurse for a wife and caregiver. She was able to help me with two fistulas that formed just two weeks after surgery. They had to be packed daily with saline soaked gauze and we said many times, what do others who don't have a background in nursing do to get past this situation. Most of the home health nurses were not familiar with the packing procedure for the neck and my wife would have to repack within an hour of them leaving. She also kept my spirits up and reminded me each day that things were getting better. This kept the dreaded depression, that we all go through, at bay.
Fourth, is the loving support I received from my family and friends who worked with me to improve my voice to a point where I am very easily understood. It was not easy in the beginning but they never gave up on me and encouraged me to repeat the things they did not understand.
Finally, was the encouragement of a wonderful SLP, Ann Cyptar, for me to start my own Lost Chord Club and give support, assistance, and encouragement to those who were told by their doctors that they would become laryngectomees. In the past three years since the Peninsula Lost Chord Club has been in existence, I have felt a real calling and have been blessed to have met and helped some extraordinary individuals.
Tom Olsavicky, Pres.
Peninsula Lost Chord Club
Newport News, Va.
Jim Fohey, Oscoda MI - class of 94
As of October 13, I will have a been lary for 18 years and I am thankful for the skill of my surgeon in making it possible for me to be here. Also, for the understanding of friends and my son for taking care of me and helping me to overcome this drastic life altering change.
As much as I knew what it would be like having had two customers that were larys and getting to know them well, you still just are not ready for and do not accept the change easily. So with two of my friends who also were employees they saw me through the dark days and gave me the kick in the butt to get me out of a funk. I thank them each year for that. I am just thankful to be here and able to do as much as I do, golf, fish, hunt, travel.
This is what I am thankful for.
Elizabeth Finchem, Tucson, AZ - 1978
Having just past the October 2nd anniversary of my total laryngectomy, and preparing for the approaching holiday season with Thanksgiving next month I am aware that I have much to be thankful for. My total rehabilitation and good health have allowed me to participate in the lives of my six adult children, nine grandchildren and one great granddaughter. That's a lot of living with graduations, weddings, births, moves, divorces, and career changes by every one of them. That is living!
I am also thankful for the opportunity to continue to serve those laryngectomees that have come after me in many ways: as a member of the IAL BOD, WW and active member of several local support groups. My main endeavor will always be teaching alarygneal speech (especially esophageal speech), and rehabilitation in general when and where ever I am invited. I believe, "it is by serving the needs of others that we heal ourselves". I am so grateful for those who were there to help me when I was a brand new laryngectomee trying to find my way in this adventure of complete trust in my Creator. Even with the usual set backs I was always shown the way forward…
Jim Olcott, Bakersfield, CA - June of 2010
First and foremost, I am thankful to be alive. I am thankful for the diagnostic and surgical team at UCLA. I am extremely thankful for the support of my wife and my family. They have been encouraging and supportive throughout the healing process and beyond. I am thankful to be able to speak (TEP). One of the biggest fears I had was not being able to communicate again after my surgery. I started with the EL and 7 months later received my puncture and prothesis. I am thankful to be able to work and play and do about 95% of the things I did prior to surgery.
Finally, I would like to express how greatful I am to WebWhispers and the members. When I first became a Lary I reached out to some individual members for specific advice and always received a welcoming response. In the morning, after coffee and the paper, I go to the computer for the WW entries. These entries from members have become an important part of my life. I look forward to the sharing of experiences and solutions to problems. Thank you, WebWhispers.
Dave Greiwe, Columbus, IN - 5/15/98
I am most thankful for ....
My God, for not abandoning me when I abandoned Him, in that terrible first year following my surgery.
My wife, for nursing me back to health, for loving me and never giving up on me, and for having more faith in me than I had in myself.
My daughters, for their loving, gentle support, and for giving us four beautiful grandchildren.
My brother and his wife for their love and unwavering kindness in our time of need, and in all of the years following.
My friends. co-workers, and every person I have met in the last 14 years who seem oblivious to my condition, and treat me like nothing has happened.
Webwhispers, for making it possible for thousands and thousands of people to find hope, support, and inspiration when it is needed the most. I am one of them!
Happy Thanksgiving to all.
Peter Powell - 2011
I had several surgeries after the first one removing the original tumor from the sublingual area. Part of the tongue was removed, also affecting swallowing. I am not able to make all of the sounds but am trying esophageal speech, as well as EL use. Life goes on and I celebrate it with my brand new grand daughter, which was the main reason I decided, upon recurrence of tumor in esophagus, to go for the whole enchilada!
Peter Poll and his granddaughter, Townes Sibley Powell
Neil Arnold - 2011
Neil Arnold had his laryngectomy on August 28th, 2011 and we had a trip planned to take our thirteen year old granddaughter to NYC in mid-October. He insisted he was ready and would not consider postponing the trip. We spent 4 whirlwind days doing all the touristy things: Empire State Building, Statue of Liberty, Ground Zero, Time Square, SoHo, Broadway Shows and much more. It was a wonderful trip with great memories for all of us. Here are a few photos hightlighting our trip. Naomi
1. Neil and Minnie Arnold at Ground Zero
2. Neil and Minnie Arnold at the Statue of Liberty
Ann Mathias, Langley BC Canada - 2009
This picture was taken on Mother's Day 2012 and without my lifesaving lary in August of 2009 I would never have gotten to see the two youngest of my three wonderful grandchildren, Ashley, 6; Caryss,1; and Adam, 9 months. Life is good, I returned to work early in 2010 and am now looking forward to retiring in December, cruising with some of you in January and meeting more of you next June in Spokane, a gorgeous scenic drive through Washington from my home in Langley B.C.
Grandchildren - aren't they great? It is great to be alive! Here I am with my sons, grandsons and great-grandson!
Many of my travels involve visits with other laryngectomees or laryngectomee organizations around the world whenever possible. Back in 2006, one of the best trips I ever took was a flight to Amsterdam and then fantastic drive across Europe, courtesy of Marianne Kooijman a long time WW member, IAL board member, and a past president of the Confederation of European Laryngectomees (CEL). We were joined by Barb Nitschneider, former IAL Secretary, and our destination was the CEL conference that was being held in Croatia. After the conference, I traveled by train to the city I had long dreamed of seeing someday, Florence, Italy. Unfortunately I had developed a bad respiratory infection the day before I left for Florence and was very ill the entire time I was there.
However, this story is about my vow to return to Florence someday, see what I missed, and re-visit other treasures I had briefly seen. The return took 6 yrs. to accomplish and it was strictly pleasure with no laryngectomee visits in the plans. Plus it was a nice birthday gift to myself.
Our departure city was San Francisco nonstop to Paris and then on to Rome. Rome is truly amazing and has definitely made it to the top of my “re-visit” list. We only allowed ourselves 3 days in Rome since Florence was the primary destination and we truly got the most out of it. The first full day was just a self guided walking tour through the streets of Rome where we visited Trevi Fountain, The Spanish Steps, a wonderful park, and did general sightseeing. All of which was free so that was really good. The next day we did the Vatican…. Wow! This is a must see whatever religion you are. The history, the art, the buildings, and St Peter’s to go with it. I went to Rome for one primary reason. To see what I think is the greatest work of art in the world… The Sistine Chapel! I was definitely not disappointed. One of our members (Dick Strauss) sent a link that I urge you to visit: http://www.vatican.va/various/cappelle/sistina_vr/index.html. It is an interactive website of the Sistine Chapel that allows you to pan the entire ceiling and zoom in or out. Really fantastic.
Rome was easy to get around since all the old stuff, the good stuff, is located in the old part of town and you can walk to most it. Beautiful old narrow streets with lots of shops and many places to eat. We found a favorite place for dinner that was very affordable and only a 10 min walk from the Eden Hotel where we stayed. The hotel was great (and pricy) and we really loved the terrace bar in the evening. But at $22 per martini or $16 for a beer we didn’t spend a lot of time there.
On the 4th day we headed to Florence via train. This was so simple with express trains running almost every hour and the trip was only about 2 hours. Got ripped off by a cab driver that charged $17 from the train station to the St Regis Hotel which we later discovered was only about a 15 min walk but not something you want to do with luggage. The hotel was magnificent, as is Florence and as Florence will always be. Once again, as in Rome, Florence is a great walking city and you can see most of everything within a 20 minute walk. The highlight for me is of course the Uffizi Museum which is rated one of the top 5 in the world. Sculpture is everywhere and of course the “David” by Michelangelo is superb and arguably the greatest sculpture in the world, except there are so many great ones that it is hard to name just one.
Aside from seeing the museums, the churches, the architecture, shops (famous for handmade leathers), the many restaurants, and galleries we also took a bus tour to Siena and San Gimignano. Siena is famous for its beauty and rightfully so. A small town with very limited traffic that is a well preserved centuries old treasure. It does have some fairly steep hills and the only way around is walking, so take that into account. I don’t walk well anymore and it was a strain but I survived it and was glad I made the effort. San Gimignano is equally nice (a walled fort city) but it’s mostly just a tourist stop whereas Siena is a residential center rather than a designed tourist attraction. However both are well worth a visit.
I have included a few photos with this article but if you would like to see more I have an album posted on ShutterFly that you can see here: http://tinyurl.com/9acwklt
I strongly urge you to consider Italy as future vacation spot. Florence is of course my favorite place and I will hopeful return once again in the future.
Maybe someday WW will do a Mediterranean Cruise with a destination stop in Venice, which I’ve yet to see. Then it’s only about 2 ½ hrs by train to Florence and perhaps a return to Rome as well.
Time will tell.
THE COLOURS WE SEE
We take all colours for granted,
as we see them every day.
our world so lovingly painted,
every hue in sweet array.
But what of those, made cruelly blind,
or have a mistiness, there to stay,
how could nature, be so unkind,
when to those, their world is grey.
A world without colour,
would be dim without their light,
sad flowers would gasp for colour,
if the sun stopped shining bright.
The meadow grass, so green and calm,
would be grey with sadness too,
and golden corn, their stately charm,
would vanish in a greyish dew.
And trees so bare, without green leaves,
would look odd to say the least.
Like some old coat, without its sleeves,
not a beauty, but a beast.
No bright yellow sun, to make us warm,
no blue sky, that we see above.
No rainbow there, to follow the storm,
showing colours that we love.
There are thousands of colours,
that we see every day,
because God gave those colours,
to help lighten our way.
So spare a thought, for those of us,
whose world is only grey.
So live your life with little fuss,
and be thankful every day.
Sending Photos or Attachments
The personal computer and the Internet have dramatically changed every aspect of our lives. We (most of us) have lived through and witnessed the remarkable and unimaginable advances over the last three decades.
Once Upon a Time
Thirty years ago to simply send a family update to loved ones in another state you had to sit down and write out a letter, perhaps sending along recent photos and enclose them in an envelope with the postage applied. Then you would need to take it to the mailbox or hand it to your mail carrier. With no storms or other delays your loved ones would have your update in hand in 3-4 days and the precious 3x5 photos you included of the kids.
Today's internet allows us to send our letters, photos, videos and even our social interests in a matter of minutes to as many of our friends and family as we care to.
My children are all grown with families of their own while we are somewhat spread out across the country we keep each other updated with emails and pictures of grand children and, of course, the latest school projects. I created a folder in my yahoo mail account called “family pictures” so that I can save each of the emails with the pictures in one place. The pictures are best when sent in the JPEG or BMP format...since it allows the person receiving them the most flexibility in what they can do with them.
To send your photos simply compose your new email message and on the upper left side click on the “attach” button (This attachment button, which looks like a paper clip is in the upper right corner in some mail programs.) This will take you to a directory window that allows you to select the picture file you want to send...sending your pictures as attachments is better than trying to send the picture itself as an email since it reduces the size of the email's content.
If I want to send my children (all 4 at once) an updated picture of my wife and me at a friend's BBQ, I would compose an email and select the address group I have created in my email program called “The Kids”. Then, add the photo from my picture folder as an attachment to the email. I can even add a note that includes when and where the photo was taken.
To keep your photos organized and easily accessible, you might want to try Picasa, a free program from Google. You can read about it or download it at http://picasa.google.com or from your favorite software source. Picasa allows for a myriad of ways to edit, categorize, share, upload and enhance your digital treasures.
Along with this marvel of near-instant communication comes the need for caution to protect our privacy and personal information.
Safely Sharing Information
Computer and Internet Security - Free
Along with this convenience of electronically transmitting our updates comes the threat of our personal information being “hacked” (stolen). This means that you should have your firewall active, as well as, an anti-virus program providing real-time protection.
Should you have any concerns about your system’s security visit your ISP's (Internet Service Provider) website and visit the section called security. Most ISP's will have firewalls in place and some even offer you the free download of Norton Security Center or McAfee Internet Suite. I know Comcast offers Norton Security Suite as a free program to it's internet customers, your ISP may vary the selections available.
Free anti-virus programs are available at online sites and we will discuss these in future columns. In the interium, you can find trustworthy sites, read to get educated and download free programs at:
http://www.cnet.com or http://majorgeeks.com
Stay secure by updating insecure programs on your computer with the Secunia PSI
“The Secunia Personal Software Inspector (PSI) is a free computer security solution that, simply put, scans software on your system and identifies programs in need of security updates to safeguard your PC against cybercriminals. It then supplies your computer with the necessary software security updates to keep it safe and makes updates automatic.
The Secunia PSI 3.0 is complementary to antivirus software, and is essential for every home computer. This is one of my favorite free for home users security programs. Updating is critical to a safe system since most program updates are released to plug holes in the software that have been found to be a way for hackers to gain access to your system. You can download and install PSI by going to http://secunia.com/vulnerability_scanning/personal/
Press the download button and once it is downloaded “run” the installation package. The program is self installing and will scan your system for your programs. Once the scan is complete it will give you a report of your programs and of any that need to be updated. By simply clicking on the programs that need updating PSI will download them for you and begin the installation process. Once the initial scan and updates are complete, PSI will continue to run in the background for you to ensure your system stays current and secure.
Got a PC problem or question?
Drop me a note at email@example.com and I will try to answer it for you in email or in this column. If you have an idea of what you would like to learn about your computer, write a question for me!
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