Internet Laryngectomee Support
January 2003
Internet Laryngectomee Support
January 2003
New Hands-free Valve in Town - ATOS "Free-Hands"
TEP prosthesis users who wish to speak without occluding their stomas
with thumb or finger now have another option. The Swedish company, ATOS
Medical, obtained FDA (Food and Drug Administration) approval this fall for its
entry into the hands-free valve market with its "Free-Hands" HME (Heat/Moisture
Exchange). As is the case with the other hands-free valves available from
Inhealth and Bivona, the ATOS "Free-Hands" is available by prescription only,
and is Medicare reimbursable.
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Also, like the Inhealth "ATVS" (Adjustable Tracheostoma Valve) system and
Bivona's, the ATOS "Free-hands" system combines the benefits of using an HME
filter with hands-free occlusion of the stoma with the valve part of the
system. As the name implies, the HME conserves both heat and moisture from
exhaled air by storing them temporarily in a filter until it is reused the next
time the individual inhales. In addition to conserving heat and moisture, it is
a very effective filter for airborne dust and germs. As is also the case with
the other brands, the ATOS filter cassette contains what amounts to salt in
them. This helps to attract and hold more moisture. Like the competing
products, the filter cassette is designed to be changed daily.
All hands-free valves work in basically the same way, but use different
mechanical means to accomplish the same tasks. There are two ways the
hands-free valves are attached to the user. One is with an airtight glued on
housing as shown in the "Free-Hands" photo. Another way the hands-free valves
can be used by some laryngectomees is with the Barton-Mayo Button. * When the
user exhales, the air pressure closes a valve. Just as the thumb does when you
cover the stoma manually, air from your lungs is then redirected through your
prosthesis and into your esophagus where it vibrates the top section. This
produces the tone you then use to form sounds and words. When you inhale, the
valve opens up again and the air goes down into your lungs for breathing.
The design of the ATOS Free-Hands is significantly different from the other
products available. One design difference is the location of the filter under
the valve assembly. The models from the other manufacturers have the filters on
top of the valve. Another major difference is the cough relief feature. The
hinged "lid" of the Free-Hands is held in place by a magnet. If you cough
unexpectedly, the pressure from the cough opens the lid. This does several
things, with the most important that it keeps the entire valve from popping out
as a result of a forceful cough.
Another major design difference is that the air for breathing comes in at
the sides of the valve assembly and not the top. The company thinks this design
is less likely to cause any blockage by clothing of incoming air.
Another significant difference between the ATOS product and others
available is they way they are adjusted. ATOS recommends (based on FDA
requirements) that the valve be initially adjusted by a clinician...ENT (Ear,
Nose, Throat) MD, or SLP (Speech/Language Pathologist). This allows for
differences in the amount of pressure the speaker uses to obtain TEP voice.
There are two adjustments possible. One is to the magnet, and another to the
diaphragm. A little tool is provided with the kit and it is used to change the
distance from the magnet and the little metal attachment plate.
The Free-Hands also comes with a cleaning kit. All hands-free valves are
designed to be removed at night (FDA requirement), and ATOS also supplies a
cleaning kit. You put water into the cleaner, and then add a denture cleaning
tablet and the valve. It is designed so that the HME is both clean and dry by
morning.
As might be expected from an imported higher tech product, the ATOS
Free-Hands is more expensive than the other products available. The complete
kit comes with the valve, 2 base plates, 5 filter cassettes, cleaning kit,
adjustment kit, and directions. The cost is $270. Replacement glued on
housings cost from $2.93 to $6 each in boxes off 20, and the replacement filter
cassettes are $2.54 each in boxes of 20. However, the Free-Hands is designed to
fit into the housing made by the other manufacturers, and cost conscious larys
may want to seek a less expensive glued-on housing on a trial basis. ATOS will
take Medicare "assignment" based on prior approval.
ATOS's competition will be announcing an improved product soon, and there
are rumors of the entry of another company into the hands-free valve market.
It is always good to know that manufacturers are working on the development of
new products for laryngectomees. All of us benefit from their
competition and the resultant choices they provide.
* Unfortunately, not all sizes of the Barton-Mayo Button have the exact same
outer opening diameter. According to reports from users, the ATOS (and other
valves) are often loose in these Barton-Mayo Button sizes: 10 regular, 11 long,
12 short, and 14 long. An airtight fit is needed for use with any hands-free
valve.
WW Member Judy Ramboldt Becomes FLA
President
Congratulations are in order to WebWhispers member
Judy ("Hear me roar") Ramboldt upon her election this fall as President of the
Florida Association of Laryngectomees. The FLA is among the biggest, oldest,
and most solid of the State clubs. Elected along with Judy were, (in order in
the photograph) Amy Joe Kiger (Secretary), Judy Ramboldt
(President), James Sullivan (First Vice President), Carl Kilmer
(Second Vice President), Earl Mogk (Treasurer), and Charlie Nail, Bill
Ramboldt, and Jerry Hough (all Members-at-large). (All italicized
names are WW members.)
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The fall FLA Annual Meeting featured sessions on basics for beginning and
advanced esophageal speech, using and fitting the TEP, use and maintenance of
the artificial larynx, pulmonary function after laryngectomy, Florida's program
for the hearing impaired, and effective use the AL on the telephone. A number
of nationally known speakers attended and addressed the attendees. Individual
speech evaluations by certified speech-language pathologists were also available
for laryngectomees, and the Annual Meeting ran concurrently with the FLA’s first
Head and Neck Cancer Rehabilitation Seminar for professionals headed by Dr. Ed
Stone. This seminar replaces the FLA Voice Institute and included topics beyond
larynx cancer on the rehabilitation of other head and neck cancers.
Congratulations to Judy and all of the other FLA officers.
WW Members Bob and Lesley Herbst Host
Fundraiser
An inaugural benefit dinner and party was held this past November in
Wallingford, Connecticut. More than 100 guests gathered at a restaurant to
raise money for a scholarship fund for deserving graduate students in speech
language/pathology at
a nearby university. The scholarship fund was established
by WebWhispers members Bob and Lesley Herbst at Southern Connecticut State
University in April of 2000. Bob and Lesley had raised over $10,000 in the
succeeding year and a half, and family, friends and co-workers added over $3,500
to that amount at the November fund-raiser.
The State of Connecticut has a program where any individual or group who
puts at least $10,000 into a scholarship fund will have anything above that
amount matched 50% by the State. So the total raised with their benefit was
actually $5,250. All of these efforts have the fund approaching a total of
$20,000, and the interest from the fund pays the scholarship.
One way the Herbst's have added to the fund themselves is by donating money
to the fund instead of giving birthday and Christmas presents to each other.
But Bob reports that Lesley insists on keeping Valentine's Day and their
anniversary to themselves. Congratulations Bob, Lesley and friends.
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Bob and Lesley can be reached at
bobh@i2sworld.com
Atlanta to Host 2003 IAL Annual Meeting
and Voice Institute
The Greater Atlanta Voice Masters
club is hard at work along with IAL Vice President Bob Mehrman in putting
together an outstanding program for the 52nd International Association of
Laryngectomees Annual Meeting set for June 26-28, 2003, and 43rd Voice
Institute, which begins two days earlier on the 24th.
David Kilgo is the new president of the Atlanta club and he has put
together a planning committee including Vice President Janice Hayes, Treasurer
Judy Naglit, Shirley Olson, and Mark Crowe. The Atlanta club, founded by former
IAL President and IAL News editor, the late Jane Del Vecchio, was the
host club for memorable Annual Meetings in both 1979 and 1985. (See "Legendary
Laryngectomee" - Jane Del Vecchio in
http://www.webwhispers.org/news/jun2000.htm ).
The headquarters hotel is the Sheraton Colony Square in the heart of
downtown Atlanta and it is close to shopping and transportation. A hotel rate
of $100 per night single/double has been obtained. See the January issue of the
IAL News for registration and reservation information, and see
http://www.larynxlink.com/Atlanta/Atlanta_1.htm.
And as always, WebWhispers will have a great reception and
dinner in Atlanta. Great airline fares are available to Atlanta since it is an
airline
hub city, and a great turn-out is expected this year.
Larys and Clean Beds
An article in an issue of the
Headlines newsletter some years back addressed one aspect of keeping the air
reaching our lungs as clean as possible by discussing keeping our beds clean.
In addition to changing the bed sheets and covers more often than we might have
before becoming laryngectomees, there are some other things which might be
considered.
We have learned that by becoming a laryngectomee the top half of our
respiratory system has been cut off from the lower half. We lost the heating,
humidifying and filtering effects of the nose, mouth and throat. Prior to the
laryngectomy, the part of our respiratory system below the throat was considered
to be medically "sterile" (germ-free under normal circumstances). This is no
longer the case after becoming laryngectomees, so we are at greater risk for
lung infections than before. Another interesting fact is that in
non-laryngectomees their respiratory systems filtered and removed 90% of
contaminants entering it within an hour. Now, the only thing between our lungs
and the outside world is the short length of our tracheas and the mucus in it
and in our lungs. That is the case unless we put something else in between
them such as an HME
(Heat/Moisture Exchange) filter, foam or cloth cover.
Another interesting fact which impacts many laryngectomees is that tobacco
smoke kills respiratory cilia...the tiny microscopic hairs which propel mucus,
and any contaminants trapped in it, upwards so we can cough it out. Without
many respiratory cilia the conveyor-belt motion of the cilia is lost, and the
only way we can get rid of the mucus is by forcefully coughing it out. This is
why some laryngectomees need to use the irrigation (lavage) technique of using
saline bullets or saline spray to introduce moisture into the trachea and
lungs. This initiates the coughing necessary for them to clear their lungs.
One way you can tell if you have adequately working cilia is if mucus "wicks"
its way to the stoma, or there is always watery mucus just below the lip of the
stoma.
At the insistence of the FDA (Food and Drug
Administration), producers of HME filters advise laryngectomees to remove them
during sleep. So if that advice is followed, laryngectomees only have foam
and cloth filters to wear overnight.
Wearing a stoma cover of some sort
24 hours per day is highly recommended by respiratory specialists who understand
how the anatomy of laryngectomees has made us more vulnerable.
Although we are not aware of it, we
human beings constantly shed skin. The outer layer dies and flakes off, to be
replaced by new skin cells. Human skin (dandruff) is a major component of what
we call household dust. And this dandruff accumulates in our bed sheets and
blankets, and into mattresses. And the accumulation of dandruff attracts
microscopic animals which feed on it - dust mites. Both human dandruff and dust
mites are a source of allergic reactions for many. And if this material is
breathed in, our systems must get rid of it. So reducing it, particularly
around our beds, is a good idea.
As mentioned, a way to help the situation is to change the bed sheets and
blankets weekly. Another suggestion is that while the bed sheets are off the
bed it is a good idea to vacuum the top of the mattress, paying particular
attention to the seams. Doing what we can to keep our stomas covered and
reducing the contaminant load our respiratory systems must remove should make us
all breath a little easier.
Quick Tips
If you wear cloth stoma covers with
Velcro fasteners, you can make the Velcro last longer if you stick the two parts
together when you are getting ready to wash them. Doing so protects them during
both washing and drying from mechanical wear and accumulation of fibers in the
Velcro hooks.
Shipping an AL or other electronics device through the mail? The Post
Office now requires that the batteries be removed from the device. They can be
along with the device, but just not installed.
Lary Laughs
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Welcome New Members
We welcome the 20 new members who joined us during
December 2002:
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Dowell Barnes Key Largo, FL gizmo9@bellsouth.net |
Beverly Brown Spring Valley, CA wm.brown@cox.net |
David Carr London, UK artdcuk@yahoo.co.uk |
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Patricia Clark Boxted, Essex, UK Laceymarie62@aol.com |
Ed DeBaugh Arlington, WA p3orion@earthlink.net |
Michael Eaton - Kapitex Healthcare Wetherby, UK mre@kapitex.com |
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Douglas Edwards West Allis, WI charoedwards@yahoo.com |
Deb Holton Tallahassee, FL spaaztic1@aol.com |
Larry Ingmire Sparks, NV Exfire55@msn.com |
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Victor Irby Greenville, SC jarhead5660@charter.net |
Joseph McCord Eatonton, GA jmccord3@bellsouth.net |
Janet Mary Mooney Mersyside, UK jan@moon.ology.org.uk |
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William Peak Evansville, IL wopeakjun@sigecom.net |
Jodi Pierskalla - Caregiver Maynard, MN countrygirl@hcinet.net |
Mary Russell - Caregiver Glasgow, KY maryiola@alltel.net |
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Louise Simm New Port Richey, FL louise.simm@verizon.net |
Winston & Kathy Slay Tallassee, AL wslay1952@hotmail.com |
Jim Stringer Houston, TX jstringer6@houston.rr.com |
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Gary Wallesen Vancouver, WA gjwallesen@juno.com |
Earl Williams Paget, Bermuda skipjunkie@hotmail.com |
