| Name Of Column | Author | Title | Article Type |
| Roger's Ramblings | Roger Jordan | Scooting Around | Experiences |
| VoicePoints | Jeff Searl, Ph.D. | Yeast InTE Prostheses | Education-Med |
| Musings From The President | Murray Allan | Happy New Year Greeting | News & Events |
| News, Views, & Plain Talk | Pat Sanders | What Is The IAL Annual Meeting | Experiences |
| Bits, Buts, & Bytes | Dutch | Computer Tips | Experiences |
| Welcome New Members | Listing | Welcome | News & Events |
SCOOTIN' AROUND  I bought a very light weight one, only 65 lbs., that I use
exclusively for air travel. The airlines check it as baggage, I ride it right
to the gate and it is delivered to me at the gate of my final destination.
If I have to change planes, the airlines all provide wheelchair service from
gate to gate. Once I get my luggage and clear customs, if applicable, I
stow the luggage to the cab area. The scooter handle bars fold down and
the seat easily comes off so it will fit in the trunk of most vehicles (no tools
needed). As I recall, I paid about $1700 for the unit.
At home, I have a larger scooter, a Pride Celebrity 3 wheel, pictured at right,
which is faster and has a larger basket for carrying things. It, however
weighs about 165 lbs. and I put a Bruno lift in my Safari GMC van to load and unload
it. I do prefer the larger unit, as I weigh over 200 lbs. myself and the
lighter travel scooter, though rated for 250 lbs., strains on even a moderate
grade, and the battery charge doesn't last nearly as long. Anyone with trouble walking should consider getting a
scooter. In many cases the VA, Medicare, or private insurance will pay
most of the cost, including the lift for a van. The VA will also pay
$9,000 for the first time purchase of a van needed by a service connected
disabled veteran to transport his or her scooter. I was unaware of this
benefit when I got my first scooter and bought the van myself. The VA did
install the power lift. I bought the light weight scooter from a scooter
dealer near Tampa. But there are many brands of both types of scooter and
they all advertise extensively.I wholeheartedly recommend getting one. It will return those who need one to the world of the mobile population. In fact, Joy can't keep up with me in stores or malls. At Disney World in Orlando, I outran Joy and my daughter and her husband. And as a side benefit, scooter users and their entire party go the head of the line at Disney. On that occasion, I drove to Orlando so had my larger scooter with me. An overnight charge of the battery lasted all day with no slowing down. With my smaller scooter, I would have had to plug it in periodically during the day. In Las Vegas, for example, I would plug in at lunch in a restaurant and again at dinner. Each time, this would provide sufficient power for a few more hours.
There is a fascinating world out there. The
opportunity to meet and learn from so many other larys is just a part of it,
albeit a very important part to us. So get a scooter and hop aboard. ************************
[
? 2004 Jeff Searl, Ph.D. ] Yeast Colonization of Tracheoesophageal Voice Prostheses By: Jeff Searl, Ph.D., Assistant Professor, Bowling Green State University, Bowling Green, Ohio Over the past 25 years, tracheoesophageal (TE) speech has become one of the primary communication options available to individuals after laryngectomy. The resulting speech can be quite intelligible in most TE users and a large percentage of laryngectomees that try TE speech stick with this method for the long-term. However, one persistent difficulty that some TE users face is premature failure of a voice prosthesis because of a build-up of yeast on or near the valve. When this happens, the valve may not function properly. As most TE users are aware, there is a small one-way valve housed inside the voice prosthesis. When voice is not being produced or when swallowing, this valve is in the closed position. This means that the voice prosthesis is blocked by the valve so that saliva and liquids are unable to flow from the esophagus to the trachea. During speech, air is directed into the voice prosthesis from the trachea, pushing the one-way valve open, allowing air into the esophagus to be used for producing voice. What Happens When Yeast Builds-up on a Voice Prosthesis? If yeast builds-up on the voice prosthesis, particularly if it is on or near the one-way valve, the opening and closing of the valve can be affected. Some TE speakers may experience leakage of fluids (either saliva or liquids being swallowed) through the prosthesis because the yeast colony is preventing the valve from closing. This usually causes the person to cough and is generally considered to be unhealthy for the lungs if the liquids make it to the lungs over a long period of time. Although perhaps less common, in other TE speakers the yeast build-up can interfere with the opening of the valve when they try to talk. If the yeast colony is in just the right spot it may only let the valve open partially which could reduce the amount of air flowing from the trachea to the esophagus when they try to speak. This could negatively affect their voice (e.g., decreased loudness, trouble starting the voice, no sound coming out, having to work harder to get voice, etc.). Where Does it Come From? The mouth is the primary source of yeast that can ultimately grow on the voice prosthesis. Yeast is actually a term for fungi. All individuals, whether they have a laryngectomee or not, have a certain amount of yeast organisms (as well as bacteria and other things) in their mouth. Yeast is said to colonize when there is more than the usual growth of the fungus in a given location. An example that many people are familiar with is oral thrush, which is usually a whitish, feathery, sore patch that can show up on the tongue or other parts of the mouth and throat. Yeast from the mouth is carried into the throat and then the esophagus when a person swallows saliva. In TE users, this creates the possibility of yeast coming into contact with the voice prosthesis where it can attach and grow.
Individuals who have undergone laryngectomy are at risk for a higher than normal concentration of yeast in the mouth, and those who have undergone radiation therapy are at an even higher risk. Following the total laryngectomy procedure, the trachea is turned to the front of the neck and is open to the outside air at the stoma. This separates the lower airway (trachea and lungs) from the upper airway (throat, mouth, and nose). Because of this, airflow in the mouth is quite different than it was before the surgery since a laryngectomee, of course, now breaths through the stoma and not the nose and mouth. This change in air flow can alter the oral ?flora,? or the make-up of bacteria and other organisms that are normally present in the mouth. Once such change occur, there can be an increase in yeast growth. Undergoing radiation therapy in the head and neck region increases the risk of yeast proliferation. Chemotherapy, or any other treatment or medical condition that suppresses the immune system, also increases the chance of yeast colonization. There are other things that can increase the risk of excessive yeast in the body (including the mouth) including over-use of antibiotics, severe burns, diabetes, and tuberculosis. What Can be Done to Help? The issue of managing or eliminating yeast colonization on TE prostheses has been a focus of concern for TE users, the ENTs and speech pathologists who treat them, and to researchers. Below are several steps that may help laryngectomees who have persistent problems with TE valve failure because of yeast growth. The approaches are divided into three categories: medications, voice prosthesis considerations, and ?other.? Medication
Voice Prosthesis Considerations The type of TE voice prosthesis used may also be a consideration for individuals dealing with re-current yeast colonization. There has been a longstanding effort to develop a voice prosthesis that is resistant to yeast. One manufacturer has recently put on the market an indwelling prosthesis in which the valve is manufactured from silicone that has a small amount of silver oxide in it. Silver oxide is known to have anti-fungal properties and so should help limit yeast development. This product is just now showing up in the clinical population and so it is expected that more and more will be published in the literature about the effectiveness of the device. Another TE prosthesis on the market that may be more resistant to the growth of yeast is the Voice Master (developed in the Netherlands by Dr. P. Schouwenburg). This particular device is not widely used, at least not in the United States. However, the body of the prosthesis consists of a titanium sleeve which is apparently resistant to the growth of candida. Another suggestion frequently made by laryngectomees and speech pathologists who work in this area is for regular cleaning of the prosthesis. The specific definition of ?regular? cleaning may be open to debate, but a general rule of thumb is that the longer the interval between changing and cleaning the prosthesis, the higher the likelihood of trouble to expect from yeast colonization. For those laryngectomees who change their own prosthesis (that is, those NOT using an indwelling device), besides regular cleaning of the device, soaking in a peroxide has been suggested as a means of killing yeast cells on the silicone. This is not specifically recommended by the prosthesis manufactures and it is unknown how the peroxide (or other soaking solutions that are sometimes discussed such as bleach solutions) might degrade the silicone material itself, although a number of laryngectomees and speech-pathologists have suggested this method. Other Things This last set of suggestions is just a short-list of some of the ideas offered by laryngectomees themselves or the professionals involved in their care. A number of individuals have increased their intake of yogurt and feel that this helps reduce the yeast colonization problem. This is used to help manage yeast issues in other parts of the body and may do the same for problems involving the TE prosthesis. As long as you like eating yogurt (it must have the live acidophilus bacteria), this seems like a worthwhile thing to try although it may not help some people. You can also get the acidophilus bacteria ( Lactobacillus acidophilus) in other forms at some health food stores. Others have suggested cutting back of foods that might promote yeast growth if there is already a small population of candida organisms present. For example, sugar is known to promote yeast growth, at least when other conditions are favorable. So, some have suggested that cutting back on sugar-laden products may be of some use in limiting growth. In contrast, others have suggested that it may be worthwhile to create an inhospitable environment for yeast growth via the food that is eaten (e.g., acidic types of substances). However, I have not seen any specific research literature addressing dietary issues and TE voice prosthesis yeast colonization. The primary message is that there are things that can be done to help limit, and in many cases eliminate, problems with TE voice prosthesis failure secondary to yeast colonization. Use of Nystatin (and possibly other antimycotic medications) is a fairly well accepted technique that has been found useful by a number of individuals. The development of fungus resistant voice prosthesis also represents a nice advancement for helping to manage the problem and more information on theses prostheses should be forthcoming in the literature. Finally, laryngectomees themselves (and their speech pathologists) are often a vary resourceful lot. They will likely continue to explore their own ideas about ways to help manage the problem. One must be careful of accepting all the suggestions offered even if it seems to make sense, checking with others (most notably your doctor and speech pathologist) in order to avoid any unintended harms.
What is the IAL Annual Meeting? We had a great article by Dr. Ed Stone about the Voice Institute in last month's issue of Whispers on the Web but there are some people who want to know what the Annual Meeting has to offer, when to sign up and what to do there! Murray Allan had this to say about the next meeting site, " Currently, in addition to being WebWhispers President, I am active as Chair of the Annual Meeting committee of the IAL which is holding its annual convention in Anaheim, CA from July 6 to 10, 2004 (Voice Institute: 6-10 July, Annual Meeting: 7-10 July). The convention is being held at the beautiful Anaheim Sheraton which is just three minutes from Disneyland by shuttle. What a great chance it is for everyone to gather with their friends and enjoy the wonders of this marvelous attraction at the same time. We are trying to obtain reduced rate passes for evenings at Disneyland. I have attended the hotel for an interim meeting and it is truly a first class establishment with a staff to match. If you can possibly make it, don't miss this great meeting." Here are some personal thoughts. Do your registration online or by snail mail well in advance (see Dutch's column in this issue for how-to). Then decide what day you are going and make your hotel and airline reservations If you don't have anyone to share a room, the IAL or other WW members may be able to help with that. You will be able to visit the IAL registration desk at the hotel on Wednesday afternoon (July 7th) for early registration but officially Thursday is the start of the AM. You will be given a nametag with ribbons, some of which indicate that you are a newcomer or a delegate! There is always a "goody" bag with an assortment of nibbles and gifts. The AM schedule shown on the web at the present time is under construction and there will be a lot of additions and changes made as speakers are confirmed but it will give you a general idea. There will be opening ceremonies and they are always exciting and impressive. This event is shared by both the VI and the AM attendees. At various times during the entire convention, there will be shared activities. At other times, there will be speakers in the AM section, or a choice of activities with some business meetings going on at the same time. It can be a little like a 3 ring circus with lots of things going on. In addition, you may choose to attend the VI classes if you sit in the back, observe and listen. Since you are not signed up for the VI, this is a courtesy extended to you if space allows. Some AM speakers will be professional and some will be laryngectomees or other parties with expertise in their field. I have been asked to lead a discussion this year for the AM and I suggested the topic of Newsletters. I would hope to have in attendance other editors with copies of their newsletters and people who want to start a local newsletter or need ideas for existing ones. We can share with each other and each go home a little wiser. Vendors will have tables set up and it is difficult to find enough time to see everything. Plan to spend time there looking, asking questions, and sometimes trying new products. You get to see products you had only heard about. Lots of literature is laid out for the taking and there are usually some nice give-away items so carry your goody bag. There will be some evening activities, usually including a Meet and Greet and a Sing-a-long. On Friday evening, there will be a reception and dinner for WebWhispers. Details and cost will be announced later. Remember that Saturday evening's IAL banquet is already paid for with your IAL or VI registration and it is always superb so plan to go. Check over Dutch's article below to go to the web site and browse for more information.
flame 1. n. A hostile, often unprovoked, message directed at a participant of an internet discussion forum. The content of the message typically disparages the intelligence, sanity, behavior, knowledge, character, or ancestry of the recipient. 2. v. The act of sending a hostile message on the internet. flame warrior 1. n. One who actively flames, or willingly participates in a flame war ... (Another Example Below) ...
Above courtesy of Mike Reed |
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We welcome the 25 new members who joined us during December 2003:
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Lee & Diane
(caregiver) Allard Kirkwood, NY |
Margaret Attridge Homosassa, FL |
George Bechard Waterloo, Ont., Canada |
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Sarah Brinklow - Caregiver Brockport, NY |
Stephanie Buck Gloucester, MA |
Riley Caudill Lexington, KY |
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Walter Crosby Ann Arbor, MI |
Ian Currie Tauranga, New Zealand |
Robert Dlouhy Riverside, CA |
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Claude Duhamel Lafayette, GA |
Vicky (caregiver) & Gerald
Kaufman Camby, IN |
Ian Kurka Titusville, FL |
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Betty Lamppa Wyoming, MN |
Vicki Leslie - Caregiver Hercules, CA |
Clarence Lewis Beaumont, TX |
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Sharon Lickman Elsie, MI |
Sid Miller Fort Myers, FL |
Clarence Mitsdarffer Evansville, IN |
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Alan Shafran Tarpon Springs, FL |
Robert Shelton Hampton, VA |
Roger Silberman San Francisco, CA |
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Marshella Ungerer St. Joseph, MO |
Sue Ward - Caregiver Greenville, VA |
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WebWhispers is an Internet-based laryngectomee support group. It is a member of the International Association of Laryngectomees. The current officers are: 
Murray Allan..............................PresidentPat Sanders............V.P.-Web Information Terry Duga.........V.P.-Finance and Admin. Libby Fitzgerald.....V.P.-Member Services Dutch Helms...........................Webmaster WebWhispers welcomes all those diagnosed with cancer of the larynx or who have lost their voices for other reasons, their caregivers, friends and medical personnel. For complete information on membership or for questions about this publication, contact Dutch Helms at: webmaster@webwhispers.org |
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? 2004 WebWhispers |
and
Lesley Herbst from New Haven, CT, found that they, too, needed some
reliable "scooter assistance" recently. Unfortunately, Lesley had
injured her leg just prior to the WebWhispers 2003 Caribbean Cruise.
Undaunted, they arranged with a company for a rental "scooter" to be
waiting in their cabin aboard the "Navigator of the Seas" and then Lesley
"scooted" virtually everywhere she wished to go while on the cruise.
When they disembarked back in Miami, they just left the scooter in their
cabin for the company's representative to pick up. Remarkably
hassle-free!! Amazingly, the company that Bob and Lesley used
was "CareVacations, Ltd" in Leduc, Alberta, Canada!! Their web site
is at: 
There are a number of different species of yeast. The type of
yeast most commonly referenced when discussing voice prosthesis colonization
is Candida albicans, which is present throughout the gastrointestinal
tract in all individuals. However, while the albicans variety may
be the most common, it is not the only type of Candida that has been
identified on TE voice prostheses (a study from 
The recommendation offered Dr. Eric Blom and others for TE users with yeast
colonization problems involves use of a type of medication broadly classified
as an antimycotic. TE users must consult with their ENT doctor about the
use of the medication, but typically the procedure that is recommended
involves swishing 1tsp of the oral suspension of Nystatin (an antimycotic) for
a minimum of 4 minutes in the mouth twice a day. The Nystatin can be
swallowed or spit out after swishing. This helps to reduce the yeast
present in the mouth. There are other antimycotic medications such as
miconazole and fluconazole that might also have a role in managing the
problem. In a study from the 
Murray's Mumbles ... Musings from the President
Dutch's
Bits, Buts, & Bytes
ListServ "Flame Warriors"
