Title/Author Topic Article Type
Voice Master New Prosthesis Equipment
GERD Surgical Option Medical
Tobacco Nations Declare War News & Events
Cancer Diet Prevention Advice
Radiation Treatment Don't Delay Medical
Phones Tips Advice
Tobacco Licensed  To Kill Tobacco
Welcome New Member News & Events

 


Internet Laryngectomee Support
June 2003

VoiceMaster - a New Prosthesis

     One of the lesser know brands and types of prostheses in North America is the VoiceMaster.  It was developed by Professor Paul Schouwenburg of The Netherlands (Holland).  The original model was designed to be installed under anesthesia since it was inserted by a medical doctor from the esophagus side via the mouth and throat instead of the front, or stoma side.  This factor probably contributed to the smaller market for it in North America relative to the InHealth, Bivona and other front-loaded prostheses.

     The new front loading version of the Voice Master should be more popular since, while it is an “indwelling” type and not installed by the laryngectomee, it can be much more easily installed from the stoma side by a SLP (Speech/Language Pathologist), or ENT (Ear, Nose and Throat) medical doctor.

     The most unique feature of the VM is its titanium metal sleeve, or tube.  Titanium is more resistant to the growth of candida (yeast) than those made out of silicon.  As we know, the primary reason voice prostheses fail and must be changed is the growth of candida around the valve which ultimately stops it from closing all the way and causes leaks through the prosthesis. 

     The VM features a ball valve system rather than the flap type found in the InHealth, Bivona, Groningen, and other prostheses.  This ball valve design, along with the material the ball is made of, should also assist with resistance to candida.  The manufacturer also believes that the ball valve produces a stronger seal than the flap valve, and leakage should therefore be reduced.  This, in turn, should extend the life of the prosthesis before it must be replaced.

     Another unique feature of the VM ball valve design is that no gel cap is needed for insertion.  (See gel cap insertion in this issue of the WWJ: http://www.webwhispers.org/news/nov2002.htm).  This feature allows the prosthesis to be made without a safety strap, which is left on other indwelling types of prosthesis until the gel cap is dissolved and the inner flange (retention collar) is confirmed to be fully open.  Proper dilation of the puncture and some water soluble lubricant is all that is required to get a proper insertion.  Careful fitting to get the required length is, however, essential.

     As indicated by the diagram, airflow is increased around the ball (30% more compared to the flap valve, according to the manufacturer), and voicing should be easier.  The diameter of the prosthesis at 24 French is also among the largest diameter prostheses available, and this also contributes to the volume of air flow.  However, some research indicates that the larger diameter prostheses may develop more leaks around the prosthesis than smaller diameter ones such as the 16 or 20 Fr. prosthesis.  The VM prosthesis is considered to be an "ultra low pressure" type of prosthesis.

     The VM comes with a disposable insertion tool.  It functions by pushing the ball valve forward.  This straightens out the three pronged inner flange for insertion.  The insertion tool has a color coded system which indicates when the prosthesis is attached to the inserter (yellow is indicated on the inserter), and green when the prosthesis is stretched out fully for insertion.  The plunger on the inserter is then withdrawn, and the inner flange of the prosthesis opens on the esophagus side.

     The price of the VoiceMaster is U.S. $227.60 (compared to $199 for the Provox II or $99 for the InHealth indwelling prosthesis).  Like all prostheses, it is a prescription product available through your ENT or SLP.  See your SLP or ENT for additional information.  It is distributed in the U.S. by Hood laboratories, 575 Washington Street, Pembroke, MA 02359.   (800) 942-5227  (781) 826-7573.   http://www.hoodlabs.com

(Information for this story came from company literature, website, and an article on prosthesis diameters by Dr. Eric Blom.)

Another Surgical Option for GERD

     Another minimally invasive surgical procedure which can be done on an outpatient basis to treat GERD (GastroEsophageal Reflux Disease) is now available.  It is called the "Sretta Procedure."  A similar procedure, the "Bard EndoCinch procedure," was described in this issue of the WWJ: http://www.webwhispers.org/news/feb2003.htm.

     GERD occurs when stomach acid and bile "reflux," or move upwards, from the stomach and into the esophagus.  7% of U.S. citizens suffer from GERD.  Common names for it include "acid stomach," "indigestion" or "heartburn."  There is some research which indicates that GERD is associated with the development of larynx cancer, but it is also a frequently reported problem in laryngectomees after their surgery. 

     A properly working lower esophageal sphincter functions like a one way valve which lets food and drink enter the stomach, but not allow anything to move back up.  The development of GERD is also associated with the aging process as the sphincter muscle just above the stomach loses elasticity.  Since most laryngectomees are older individuals, more of us are likely to experience the problem.   However, in addition to the aging process, the loss or compromise of the upper sphincter muscle at the top of the esophagus as a result of the laryngectomy surgery also appears to be related to the onset of GERD, or its becoming worse for those already suffering from it.

     There are three approaches to dealing with GERD.  One of the most important is prevention.  Ideas for preventing acid reflux include (1) seeing your MD if you have acid reflux more than twice a week (2) eat 5 or 6 smaller meals per day rather than larger ones (3) avoid eating or drinking before napping or sleeping (4) after a meal avoid bending over, exercising, or lying down (5) avoid or reduce consuming coffee, tea, chocolate, citrus fruit, onions, garlic, fatty, or very spicy foods (6) reduce excessive weight and do not smoke (7) consider raising your sleep angle by propping up the head of your bed a few inches, or sleeping with the upper part of the body elevated by pillows (ideas are from the American College of Gastroenterology.)

    A second approach is the use of medication.  Your medical doctor may prescribe a drug such as Prilosec or Prevacid which works by blocking the formation of stomach acid.  Other medications protect the lining of the esophagus or speed up the time it takes the stomach to empty.
 
     A final alternative is surgery, and another new noninvasive approach has been developed which permits the surgery to be done on an outpatient basis.  This new technique is called the "Sretta Procedure."

     The Sretta Procedure is categorized as "minimally invasive."  It is done on an outpatient basis, typically takes less than an hour under local anesthesia, and the patient returns to regular activities within a day.   Actually, since larys breath through the stoma, the procedure should be medically more simply performed on them than non-larys.  A catheter is placed via the mouth down to the valve area between the stomach and esophagus.  The physician then delivers heat energy to the area of the sphincter.  What amounts to scar tissue develops which restores the function of the sphincter.  The procedure and equipment to perform it was developed by the Curon Medical company.

    A patient treated at the Stony Brook University Hospital with the procedure remarked, “It was hard to breathe from the reflux and sometimes I felt like I was dying.  For the first time in several years I did not take medicine at night and I had no symptoms,” Mr. Persaud said. “I am hopeful of feeling better, (and) having a better life with no medications.”

 (Note:  If you cannot view the animations you will need to download a free player.  These animations can be viewed using the QuickTime player available at http://www.apple.com/quicktime/download.)

(Information for this article came from the Stony Brook Hospital website, CME News, and other sources.  The graphics are from Curon Medical.  A special thanks to Deb Holton who edited the animations).

192 Nations Declare War on Tobacco

     The U.S. was among the holdouts, but the world's first treaty devoted entirely to health was finally adopted unanimously by the World Health Assembly on May 21, 2003.  The treaty is designed to reduce the nearly 5 million smoking-related deaths which occur each year throughout the world, and to help people kick the smoking habit.  The challenge is now to get the treaty ratified by the 192 nations.  Most countries in Europe and Africa said they would quickly sign the treaty, but the U.S. and China did not commit to signing.  Both countries are major tobacco producers and exporters.

     The treaty would ban advertising and sponsorships of sporting and other events by tobacco companies.  It also requires a strong and conspicuous warning label which would take up 1/3 of the packaging on cigarettes.  Additionally, it also requires that all ingredients be listed.  Finally, it also encourages governments to pass clean indoor air laws, put high taxes on tobacco, and combat cigarette smuggling.

     The treaty was a major project of the WHO Director-General, Dr. Gro Harlem Brundtland, who worked for several years to focus public attention on the health consequences of tobacco use.  Additionally, she worked on developing opposition to increasing efforts by tobacco producing countries to make up for decreased domestic consumption of tobacco by advertising and increasing its use abroad. 

     It now remains to be seen if the Bush administration will sign the treaty.  U.S. Secretary of Health and Human Services, Tommy Thompson, refused to say if the administration would sign the treaty, but said it was being studied.  One issue is whether the President can sign it, or if the Senate must ratify it.  Additionally, there are other Constitutional issues involving freedom of speech.

(Information for this article came from The New York Times, AP, and other sources.)

Diet and Cancer Prevention - Still More

     Research evidence continues to accumulate on the impact of diet in the prevention of oral, pharyngeal and esophageal cancer.  Diet appears to have protective qualities against the formation of cancers, but also in speeding healing and in the prevention of recurrences, or new cancers.

     A researcher at the University of California at San Francisco examined 35 previous studies on the impact of diet on head and neck cancers to see if they met the research standard for "causal assumption."  He concluded that, "There is enough evidence to point to a preventive role of vegetable intake, including green vegetables, cruciferous vegetables, and yellow vegetables, total fruit intake, and citrus fruit intake.  Yellow fruits are likely to be protective.  Carotene, vitamin C, and vitamin E are protective, most likely in combination with each other and other micronutrients.  The role of vitamin A is not clear because of conflicting findings in the studies reviewed." 

     Cruciferous vegetables include cabbage, turnips, broccoli, cauliflower, brussels sprouts, Kale, and mustard greens.  Yellow vegetables include carrots, sweet potatoes, winter squash, and pumpkin.

(Information for this article came from a summary of the research indicated above, a website on types of vegetables, and other articles on nutrition and cancer.)

Consequences of Delay in Radiation Treatment

     Does delay in beginning radiation therapy after surgery such as laryngectomy affect the outcome?  According to research reported in a recent issue of the Journal of Clinical Oncology, the answer is "yes." 

     A total of 86 studies from around the world were analyzed.  The use of a large number of studies is called "meta-analysis," and it significantly increases confidence in the results.  About 1/3 of the studies involved head and neck cancers, and the research was examined for the effect of delay on local control of the cancer (no recurrence), metastasis (spreading), and/or survival.

    Recurrence was higher if radiation was begun more than 6 weeks after surgery.  The evidence was insufficient on the impact of delay on metastasis or long term survival.  The authors concluded that delays in radiation treatment should be minimized.

A Hint from the U.K.

    A hint included in an issue of the WWJ over three years ago bears repeating.

     If you are sometimes not understood when you speak over the phone you might try a hint from the United Kingdom to use the NATO alphabet in spelling out your name or other words with which your listener is having a problem.  You might want to make a copy of it and put it near your phone.   (From the December, 1998 CLAN)
 
"Licensed to Kill" - Morbid Satire Taken Seriously By Many

     It has been reported in newspapers as a straight story of the incorporation of a new tobacco company.  Papers were filed and the state of Virginia issued a corporate charter to a company calling itself "Licensed to Kill."  The press release said the corporation hoped to avoid prosecution by being truthful in their name and advertising.  Their company motto is "We're rich, you're dead."

     In their introduction to the company they say, "Licensed to Kill, Inc. is a tobacco company.  We knowingly kill people for profit.  And we're proud of it.  In fact, it is the explicit aim of our corporation....  We're not like other tobacco companies that try to obscure what their business is about.  If you market cigarettes, you market death.  It's that simple.  In a country which effectively allows corporations to be formed without regard to their purpose, corporations are allowed to kill people to make money.  Addiction to cigarettes may be lethal, but profiting from spreading death is perfectly legal.  Truthfully, as a corporation, we couldn't care less about the health hazards of smoking our products.  Our bottom line is and always will be boosting profits for our stockholders. That is, after all, what corporations are about.  You could say that we're 'addicted to profit.'"  They go on to thank the state of Virginia which has "given the explicit permission by the state to manufacture and market tobacco products in a way that each year kills over 400,000 Americans and 4.5 million other persons worldwide."

     Supposedly among their planned cigarette brands in addition to "Licensed to Kill" are "Global Massacre," "Genocide," "Chain," "Serial Killer," "WMD" (Weapons of Mass Destruction).  Of special interest to laryngectomees are the supposed future brand, "Throat Hole."  Additional planned brands are said to be "Grim Reaper," "Morgue," and "Chemo."

    You can visit their website at http://www.licensedtokill.biz

    Be sure to read the message from the chairman and CEO "Rich Fromdeth" (wonderful name).  Laryngectomees involved in tobacco education with senior high school students (and perhaps junior high age) may wish to consider including this satire in their presentations.  The clincher that "Licensed to Kill" is satire can be found here:  http://www.essentialaction.org
 


Don't forget IAL 2003 in Atlanta, Georgia
24-28 June 2003
  Details at: http://www.larynxlink.com/Atlanta/Atlanta_1.htm   

Check WW attendees and Banquet Details at:
http://www.webwhispers.org/secure/atlanta1.htm    
 

Welcome New Members 

     We welcome the 20 new members who joined us during May 2003:
 

Olufemi Aderanti
Ibadan, Nigeria
kadtronics@yahoo.com		 Ronald Bakken
Las Vegas, NV
  ronnavy@cox.net    		William Barnes, III
Birmingham, AL
billbarnes@bellsouth.net
Richard Bennett
Poughkeepsie, NY
Bennettbenn2@aol.com		 Linda Butcher - Caregiver
Lafayette, IN
LButc75566@aol.com		 Joan Haynes
Conyers, GA
joandhaynes@att.net
  Lynda Hickman - Caregiver   
McKenzie, TN
dlhickman@charter.net		 Geoffrey Hogan
Calgary, AB, Canada
hogankg@shaw.ca		 Fred King
Wenham, MA
mgtking@msn.com
William Labossie
Billerica, MA
WLabossier@aol.com		 Rick Lemons
Lexington, NC
lemons0212@yahoo.com		 Karin Miller - Caregiver
Kansas City, MO
kmille23@sprintspectrum.com
Laurence Moss
Brookline, MA
Lmos@aol.com		 Linda Joan Rainbow
Cabo San Lucas, Mexico
lrainbow2002@hotmail.com		 Charles W. Reed III
Raytown, MO
reed3@sbcglobal.net
Lori Siegfried
Deer Park, TX
binkytat@sbcglobal.net		 Troy Sonnier - ATOS Medical
Frisco, TX
tksonnier@sbcglobal.net		 Marion Tomlinson
Fairfield, CT
Mariontomlinson@webtv.net
Patricia Wiggins
Danville, IL
jmw48@insightbb.com		 Sherry Wynn - Caregiver
Portsmouth, VA
BSBLMOMZ@aol.com		  

 

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