|Name Of Column
||News & Events
||Carol Stach, MA, CCC-SLPBRS-S
||Swallowing after Laryngectomy
||A Little Levity, Please
|This Lary Life
||Cruisin' With The WebWhispers
|Travel With Larys
||WW on the Celebrity Century
||Panama Canal Cruise
|The Speechless Poet
||Len A Hynds
||A Forgetful Husband
||Prose & Poetry
|Bits, Bytes & No Butts!
||The Java Chronicles
INDEX AND LINKS TO EACH ISSUE MAY BE FOUND AT: http://webwhispers.org/news/WotWIndex.asp
When we first discussed going on a 15 night cruise, I thought it would be too long, that we might get tired of it, maybe 10 days would be enough. To my surprise, it was delightful. With a small group of 24, we bonded and became a family. Others on shipboard started to recognize us as members of the same group and greeted us differently and in a friendly way. Amazing how many told me of a sister or a man down the street who had surgery like mine. We have a sampling of pictures but there will be more than enough photos and stories from this cruise to last a while.
We do have the regular 2013 cruise scheduled for a shorter one, 7 days, leaving from Port Canaveral on Oct 6. Good prices and a beautiful ship, the Freedom of the Seas. Look at our cruise Index to get to any of our cruises: http://webwhispers.org/activities/ww-cruises.asp
We have had problems with defining memberships ever since WebWhispers started and we gradually make changes to accommodate what you need from us as related to what we can offer. We have tried some things that worked beautifully and some that just brought different problems.
One of the greatest puzzles is the person who joins, puts themselves immediately on vacation and never reads or writes a single list email or contributes any advice and assistance to those who need it. We have no way of reaching this person to let them know we are having an election or have ordered new brochures for distribution and cannot even remind them that a few dollars would help us run the place. We would like to notify them when the conventions are being held and that we have a WW dinner every year at the IAL.
We are starting a new list, in which we will send only a few messages and they will not be discussion topics but notices of things we need to tell all of our members. Gradually, we expect to have all of our members on this Notices list who are not on the regular email distribution list or the Digest List receiving the Daily Whispers.
We have a new class of membership, also. Friends of WebWhispers and we will be happy to have people with us in a capacity other than the usual Patient and Caregiver, Medical, SLPs, and Vendors. They will also be on our Notices List.
This appears to be a good step forward.
Swallowing After Total Laryngectomy
Carol Blossom Stach, MA, CCC-SLP, BRS-S
Michael E. DeBakey VA Medical Center
Swallowing problems (dysphagia) can occur after total laryngectomy. The dysphagia may be temporary or long term. Risks of dysphagia include poor nutritional status, limitations in social situations and reduced quality of life.
The laryngectomy procedure involves complete surgical separation of the respiratory and gastrointestinal tracts. For this reason, the laryngectomized individual does not risk aspirating swallowed material. Instead, dysphagia following total laryngectomy is mostly characterized by problems with propulsion of material through the “new” post-surgical swallow passage (sometimes referred to as the neopharynx).
The nature and degree of surgical closure used with total laryngectomy is unique for each patient. As a result of the surgical closure, some patients may end up with a fold of tissue (pseudoepiglottis) at the base of the tongue. The pseudoepiglottis may form a pocket or pouch that can collect food or liquid, resulting in effortful swallowing when the patient attempts to clear pocketed material. If the pouch is large enough, another surgical procedure might be needed to fix the problem. Effortful swallowing might also occur as a result of the overall tightness of the surgical closure. Patients require removal of different amounts of surrounding tissue during surgery. For patients requiring significant tissue removal, the surgical closure will need to be tighter and swallowing may subsequently require more effort. In severe cases, the narrowed passage might result in backflow of swallowed material all the way up to the oral cavity or nasal passages. Liquids might be the only consistency the patient can swallow. Another outcome from surgery may be the development of scar tissue which can create a stricture or significant narrowing in the swallow passage. Sometimes this problem can be temporarily relieved with stretching procedures (dilatation). This is only done under the care of a physician. In some cases, a surgical procedure might be necessary to release the stricture.
Videofluoroscopic evaluation of swallowing conducted by a qualified speech pathologist is a critical component of post-laryngectomy rehabilitation. Not only does this dynamic radiographic procedure provide objective evidence regarding swallow function in this unique patient population, it affords the speech pathologist opportunities to introduce compensatory interventions. For example, alternating food and liquid consistencies or swallowing multiple times for each bite of food might be effective strategies for some patients. Patients experiencing backflow of material might benefit from using a head rotation to assist with opening up a narrowed area in the swallowing mechanism. It is only during the swallow x-ray that these types of interventions can be evaluated for usefulness. Diet consistency recommendations and potential for other treatments can also be addressed during the evaluation.
For patients undergoing radiation treatment after total laryngectomy, another potential problem is lack of saliva (xerostomia) which can greatly impact oral manipulation and propulsion of food. Diminished sense of smell is also very common after total laryngectomy since transnasal airflow has been removed as a result of the surgery. These factors can impact appetite and result in reduced food intake and poor nutritional status during a time when optimal nutrition is necessary.
For speech pathologists, it is critical to discuss potential for dysphagia during the pre-operative counseling session ahead of total laryngectomy. Speech pathologists must also advocate for the videofluoroscopic evaluation of swallowing post-operatively when indicated. For patients, close attention to the act of swallowing is crucial for relaying any new or persistent problems related to ingestion of food and liquid (including weight loss) to the appropriate health care professional so that appropriate evaluation and interventions can be initiated as soon as possible.
A Little Levity, Please!
Those of us of a certain age grew up reading Reader’s Digest. I suspect it is no the longer the staple of American homes the way it was back in the 40s, 50s and 60, but it is still enjoys a huge worldwide audience.
As a child I was a voracious reader so I also discovered that treasure trove early on. Initially I liked the humor columns best. Life in These United States, which I always suspected some people made up just to get the $25.00 and see their name in print. Laughter is the Best Medicine was usually pretty good but I didn’t always get it; the same with Humor in Uniform. My Most Memorable Character was iffy for me at first but I was a sucker for those long stories at the back of the magazine if they dealt with either of the two biggies : children dying of cancer, usually leukemia, and daring escapes from Communist countries especially East Germany. I was a child of my times. I was afraid of Communists and Cancer. And both were spoken of and written about with a Capital C.
Interestingly enough I have somehow managed to outlive both threats! The Berlin Wall, focus of so many of those harrowing escape tales fell in November of 1989 and childhood leukemia has gone from nearly always being fatal to having a 75% cure rate, one of the highest for all cancers. I got cancer as an adult in the 21st century when we have an amazing arsenal of weapons at our disposal for cancer and the threat of communism has changed into the fear of terrorism.
So it was with nostalgia I thought of those humorous columns the other day when a dear friend recounted how everyone from neighbors to police to medics came running when he felt a bit ill the other night and pushed his life-line button. He is fine now, waiting back on some test results, but it reminded me of a story I could submit to Reader’s Digest and get my $25 and name in print and this is the god’s honest truth.
My grandmother was a feisty lady and I loved her dearly although she was quite difficult at times. She had moved into an Assisted Living apartment and wore one of those Life-Line buttons as part of their protocol in case a resident fell or was otherwise incapacitated. Well, Grammie decided one evening that her hair needed washing so she used her walker to get to the bathroom sink. You also need to know that Grammie had one leg amputated and had a prosthesis that she named Pete but that is another story altogether. So Grammie wrangled herself over to the bathroom sink, removed her blouse and tucked her Life-Line button in between her bosom and proceeded to wash her hair. Well, as you might expect the button was activated and the aides came running only to find her with a towel and an indignant attitude. She went back to rinsing and the alarm went off again and this time the culprit was discovered ; it was Grammie’s buxom bosom! She was very proud of that incident and recounted it many times. She actually went into hospice twice and was sent home both times before she died at age 95 and we always said she took great pleasure in the drama of it all. She was something else!
Now, I have a 4 year old grand-daughter and I hope someday she will tell tall tales about me. She has only known my EL voice but is pretty good at reading my lips since I can’t use the Servox if I don’t have a free hand. The other day I had some stomach gas and it came up just as I was trying to ask her something and it allowed me a few words of inadvertent Esophageal Speech. I thought I sounded pretty cool since I had some intonation.
Kay was horrified! Her little face was big-eyed and shocked. She grabbed for my EL and cried out, “Nanny, are you okay? What is wrong with your voice? Here, use this. Use your good voice. Nanny, don’t do that again. You sounded weird.”
I didn’t know whether to laugh or cry. Maybe someday advances in technology and medicine will allow me other voice options and perhaps Kayleigh will look back on my Servox EL voice with nostalgia. In the meantime I should submit an anecdote or two to Reader’s Digest myself!
Please share any problems you may have had with procedure and/or cost.
Len A.Hynds, Ashford, Kent, England
I consider that there are two main problems for Laryngectomees undergoing dental treatment. Firstly if teeth are being removed, ( As they usually are because of our generally mature age), and a denture fitted, speech is usually distorted until one becomes used to the new configuration, and the movement of the tongue upon which speech depends, becomes acclimatised and gives very slightly different muscle movements to give a clear sound.
The second problem, and much more serious one, is that the removal of teeth exposes the blood stream to all sorts of toxic infections, which could affect the thickness of the blood, but also create a loss of oxygen in the blood.
Twenty years ago at Guys Hospital in London, the surgeon just the day before an operation, refused to operate until I had an infected tooth removed, and he was doing a single heart by-pass, and fitting American metallic aortic, and mitral valves in the heart, where the thickness of the blood must always be exactly right, and the loss of oxygen in the blood stream could be serious, to put it mildly. A very important subject. At a recent dental appointment with a Persian ( Iranian) dentist, just last month, he said that they were required to carry oxygen, but he queried where he should put the mask, as he had never thought of that problem before. When told, he ordered a throat mask.
The National Health Service in the UK is free to all, with the exception of dentistry, where a charge is made, although aged people or those on benefits of some kind it is all free.
Dave Aitchison, Canada/South Texas - April, 2012
As a young man I had a lot of dental work. Not sure why, as I followed good dental hygiene, but, such is life. A dentist is part of the Cancer Clinic where I go. Before radiation treatments the dentist pulled one molar as she said it would need a root canal to repair and there was not time. Following radiation treatment she identified a number of issues that she felt needed addressed. I am Canadian with no dental insurance. We are fortunate enough to spend our winters in South Texas, about 10 miles from Mexico and have had all our dental work done in Mexico since I retired so told her I would wait and have my issues dealt with there. Saw our dentist in Mexico and he suggested 5 crowns as the fillings were loose and underlying teeth were decaying. The work was done at about 10% the cost of the same work in Canada. I am very happy with the results. I see the Cancer Clinic dentist every 6 months for a check up. The cost of this check up is covered by our provincial health care plan but any further work is at my cost. I will continue having my teeth cleaned in Mexico twice a year.
Following radiation my Canadian dentist recommended I use two separate tooth pastes, Fluoridex Daily Defense (1.1 %, 5000 ppm sodium fluoride) in the morning and X-Pur Tooth Revitalization paste (5% NovaMin, calcium sodium phosphosilica) an hour before bed then use a fluoride tray with 1.1% NaF Gel for 5 minutes just before bed. Hopefully it will help stop further dental issues. The tooth pastes are more expensive than normal pastes but in the whole scheme of things, a reasonably insignificant cost. My saliva production has improved considerably so apparently that will assist also.
Happy to answer any questions and wishing all good luck.
Six months after radiation my front tooth broke in half. Dentist said it was caused by the radiation making teeth brittle. Cost $880. How careful can we be when eating ??
Linda Addis-Hinske, Cleveland Lost Chord Club East, Cleveland, Ohio
My surgery was over 15 years ago, October 14, 1997. I thought I had asked all the right questions regarding my surgery and the radiation treatments I would receive before my surgery. I was really prepared for the laryngectomy surgery but never thought once about my teeth.
I completed 9 weeks of radiation and three months later had the total laryngectomy. Everything was going pretty well and for a long time no problems until I noticed my teeth getting weaker, chipping easily and frequent cavities.
I went to my regular dentist, but was unsatisfied with him as he really didn't know too much about side effects of radiation so I found a dentist who deals with cancer and oral cancer patients. The first thing he asked me if I was on a fluoride treatment plan. I was NOT. My previous dentist never put me on one before my radiation treatment. Had I been on this treatment plan beforehand it probably would have saved my teeth longer than what it did.
My advise to any who are about to undergo this surgery with radiation and/or who already has had the surgery/radiation is to go to your dentist and ask for a fluoride treatment plan. They will fit you for a silicone denture that fits right over your teeth, that you fill with a little fluoride and wear for a few hours a day. Follow up 'check up' appointments are another plus as well as good dental hygeine. If you noticed something different with your teeth, cavity, pain, chipping, etc. seek a dentist as soon as possible. Don't wait.
Good luck to everyone.
Ginny Huffman, Atlantic Beach, FL
I have been dealing with dental issues since my radiation in 2005. I had very strong teeth and couldn't recall my last cavity. My dentist provided me with a mold of my teeth containing fluoride treatments but halfway through radiation, I had way too much discomfort to worry about my teeth. I was on a g-tube and struggling to retain my weight.
When my teeth began to chip away, I asked for implants. The oral surgeon obtained my field of radiation file from the radiologist and would not proceed without hyperbaric treatments. His concern was that I might not heal from the extractions with resultant infection and possible jaw bone loss. If you are at all claustrophobic as many COPD folks like me are, the hyperbaric treatments were impossible. Because of my stoma, it involved a hood and a tube to my stoma while seated for 45 minutes in a very small submarine-like chamber. I didn't last beyond the hood!
Over the years, I have made do with four root canals, five crowns, many fillings and a temporary bridge that was cemented in and could be removed for cleaning. By 2012, the tooth attached to the bridge resembled rubber and was about to go. Fortunately, my dentist told me of new research that supports surgery without the treatments. Another oral surgeon, using the same original radiology report, operated and I have four implants. Like most medical procedures, it is a longer process than I assumed. It took six months from surgery to the actual permanent implants.
I would have preferred the surgery years ago when I needed only two implants instead of four. AARP dental insurance through United Health covered a small portion of the bill which was over $10,000. It is important to confer with your dentist and radiologist and to investigate possible advances in dentistry. I'm glad my dentist was aware of the latest options.
Never had really good teeth! Was born in the depression.....In Combat in Korea, was a little waif of a lad cared by the vsiting Army Dentist--- foot treading the pedal for the DRILL! Clunk a clunk it went.
When Lary came... tooth by tooth L O S T.... first surprise after my Radiation/Chemo was aboard a CRUISE Ship-while dining... two small bottom teeth snapped off whilst eating. The rest is history and finally all mah toofies went! NO question my Cancer Life Saving treatment done took 'em off to the Tooth fairy.
OUR expense.. not a penny covered at all.
(Editor's note: A treadle is a part of a machine which is operated by the foot to produce reciprocating or rotary motion in a machine such as a weaving loom (reciprocating) or grinder (rotary). Treadles can also be used to power water pumps (as in the treadle pump), or to turn wood lathes (as in the pole lathe). In the past, treadles have been used to power a range of machines including sewing machines, looms, wood saws, cylinder phonographs and metal lathes.)
Cruisin' With The Webwhispers
First cruise - yikes! First cruise with Webwhispers - yikers! I had no idea what to expect on either front. By late December I started getting a bit anxious, but also looking forward to this great adventure.
The cruise surpassed any expectations I could have possibly had. Both from ship life to the excursion and the Panama Canal. Looking at the canal and realizing it has been operating for 99 years is just awe inspiring. The engineering at the time it was built was sheer genius.
The first evening at sea was my introduction to the Webwhispers. To be honest I don't remember too much from the evening. The group had 3 tables of 8 and Pat and I were the singles. As I arrived for dinner the second evening Pat beckoned me to sit at her table because there was the single chair. Oh Lordy! I was so nervous but I sat down and did what I do best: talk. We rotated tables most evenings which allowed for meeting and getting to know most everyone.
It was the best opportunity I have had in a very long time. I had to get to know the folks and I had to learn to listen as the sounds were new. Then I had to hear. After a few nights it was no longer an issue for me. The conversations just flowed and I was not afraid to say "Could you repeat that?" or even the uncouth "What." The background noise of the dining room and my not hearing well (one too many rock n roll concerts) didn't help. However, none of that really mattered. We had such great fun over the two weeks of cruising! Lots of laughter, lots of teasing and, for me, lots of learning. I have made such good friends and we have so much in common sans the laryngectomee.
This was such a learning experience for me. This group is proof that you can do anything you set your mind to. The folks I got to know are livin' life. There is no complaining, "what if"s or "poor me"s. It is a group of people I want to be around and do things with.
I have come home inspired to spread the word in my community about this fabulous organization. My knitting group has already had to listen to me share about my new friends. I have encouraged them to help me knit stoma covers. Well, maybe encourage is not the correct word! It probably came out as "We can make stoma covers out of left over yarn." I'm also looking forward to getting the brochures into our community here in the San Gabriel Valley (Pasadena, California and suburbs). We have a huge cancer facility nearby called City of Hope. It is well known in this area for cutting-edge cancer treatments. I have a contact there and look forward to taking brochures to them.
See you on the forum.
(Editor's note. Sandy came back from the cruise, joined WebWhispers in the new Friends of WebWhispers and we are delighted to have her with us.)
Casual pics taken during the Panama Canal Cruise.
We do not have all of our people in here.There will be more posted later at another place on our site.
1. Gail & Harry Jensby
2. Diane Shulz & Ron Kniffin
3. Judy Rustik & Penny Nichols
4. Rick Rivenbark & Nova Lacefield
5. Jack Henslee & Jeanette Thomas
6. Ron K with view from the stern
7. Ed & Barb Chapman
8. Dorothy & Tom Lennox
9. Janine & Ron Mattoon
10. Ann & Susan Mathias
11. Sandy Tocalino
12. Don & Nancy Whipple
SAN DIEGO TO FT. LAUDERDALE BY WAY OF THE PANAMA CANAL
1. Short walk to Guatemala!
2. Pacific into Panama Canal, headed under the big connecting bridge
3. Crowds up on the jogging track, Deck 14
4. In the first lock, looking back at Pacific end of canal
5. Colon, Panama - very colorful port
6. Cartagena, Columbia - a huge city
A FORGETFUL HUSBAND
I was married for 63 wonderful years before I lost my partner and as Valentine’s Day approaches I think of all the times that I forgot to sign the card that I had bought. Often it was not until presented with mine that I dashed into my bedroom to find the card and write something nice. I always wrote a rapid poem more or less in the Shakespearian style, which I knew Tilly loved. Quite ridiculous at our ages, but you know I always could see her, even in her eighties, as the beautiful young girl I married all those years ago.
So to all you forgetful husbands, a card means so much to the ladies. If you want to really astound her, here is a short poem you could add and claim as your own!
My dear if I could only tell thee,
those imprisoned words, I want to say.
But my throat alas confines me,
read the message in my eyes I pray.
How can I speak of love with no soft voice.
How can I tell, just how my heart yearns.
I must love from afar, I have no choice,
but with a passions desire that fiercely burns.
I cannot speak yet of my hearts desire,
Just read my sad eyes, so full of fire.
I had better stop there friends, before this paper starts smouldering.!!!
The Java Chronicles
We are into a new year and this is a great time to ensure your PC or Mac is as safe as can be for the World Wide Web.
Do you use Java?
Java has been in the news quite a bit lately since security concerns have been brought to light. Java is a program that allows a program to work with programs and websites that have been developed with Java.
On January 15th, 2013 Oracle has issued an update to address those concerns. You can update your system at Filehippo to get the latest version of Java.
To update you Windows 32 bit system:
or for 64 bit systems
The Department of Homeland Security has even chimed in by recommending all PC users disable Java. You can do this if you are certain you will not need it for your favorite websites. Some popular sites that require Java are EA Sports Pogo, and our own Chat room on Delphi Forums.
The below article was reported by NPR: Disable Java 7
A second opinion on CNET:Still advises disabling
In Control Panel, go to Add/Remove Programs (Windows XP) or Programs and Features (Windows 7).
Control Panel Programs list showing Java
Look for lines titled "Java", "Java VM", "Java Update" and the like, all with the Java logo as an icon.
Right-click on each, and select Uninstall.
Once you're done, you've uninstalled Java.
Didn't find any Java items in the Programs list? Then you didn't have Java on your machine to begin with.
Want to know what version of Java you have? Go to the link below:
Added just before publcation: Recent reports on the Java "fix" which Oracle released on Jan 14th have stated that the fix has, in fact been compromised already. The link below gives a more detailed report of the current Java situation:
To cut to the bottom-line: At this point in time it is best to simply delete Java from your PC and wait until the team at Oracle can safely provide us with a reliable and safe Java plug-in.
Evernote has many features for users to share and explore in this article from Making Use Of.
“Get Creative With Evernote: 10 Unique Uses You Haven’t Thought Of”
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Managing Editor - Pat Wertz Sanders
Editor - Donna McGary
The information offered via WebWhispers is not intended as a substitute for professional medical help or advice but is to be used only as an aid in understanding current medical knowledge. A physician should always be consulted for any health problem or medical condition. The statements, comments, and/or opinions expressed in the articles in Whispers on the Web are those of the authors only and are not to be construed as those of the WebWhispers management, its general membership, or this newsletter's editorial staff.
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