The field of speech pathology attracts two types of people:  talkers and listeners.  Anyone who has met me knows that I am the former and not the latter.  So it is understandable that when I began working with laryngectomees in the late eighties the primary goal for my patients was the establishment of a method of communication that would allow them to communicate their wants and needs.

            As I spent more time with the laryngectomees it became clear to me that their altered anatomy did more than just affect their ability to communicate, it affected their entire pulmonary system.  They frequently coughed and cleared secretions from their stoma.  This was because the air that they used to breathe into their nose was now going directly into their lungs.  I learned that their nose did more than just look good on their face; it filtered, warmed (to 97 degrees) and humidified (to 98%) the air.  Their nose also increased the resistance of breathing which allowed for complete expansion of the lungs. 

When a person has a total laryngectomy they become a total neck breather.  In a total neck breather inspired air is not filtered, the air temperature drops to room temperature (approximately 68 degrees) the humidification drops (to 42%) and there is very little resistance when inhaling and therefore incomplete lung expansion.  The lack of filtration allows particles into your lungs.  The lungs consider these particles ?foreign bodies? and produce secretions in an effort to move these particles from the lungs.  The drier inhaled air also causes an increase in secretions.  The colder air holds less moisture.  One of the very serious complications after having a total laryngectomy is a mucus plug or dried secretions occluding the airway.  This is an unnecessary complication. 

            So what can we do to remediate this problem?  Wear a Heat and Moisture Exchanger or HME.  An HME is kind of like an artificial nose.  It is not quite as efficient as the nose but it will bring the air temperature up to 84 degrees and the humidification up to 65% (most impregnated with calcium chloride).  It also filters the air and increases the resistance of breathing thereby allowing further expansion of the lungs. 

It will feel different when you first wear it.  You will feel an increase in the resistance when you breathe.  You may even have an initial increase in secretions but once your body adapts you will notice a significant reduction in secretions.  You should give the HME at least a seven day trial.  Many companies will give you a sample pack for seven days for you to try the product.  Some of the companies suggest that try their product for an entire month to see what the full effects of it would be. 

One of the nice advantages of wearing the HMEs is that it can improve a laryngectomee?s TEP voice if they have problems occluding a deep set, large or irregular stoma.  ?Hands free? valves can be used with HMEs. 

There are a number of manufacturers of different HME products.  ATOS has the Provox Stomafilter System (see photo below), Inhealth Technologies has the Humidifilter (see photo below), Kapitex Healtcare Ltd has the Neo-Naze (see photo below) and Bivona Medical Technologies has the HME cartridge.  ATOS, Inhealth and Bivona products are interchangeable.  For example, if you like an ATOS housing and an InHealth humidifilter, or vice versa, you can use these together. 

HMEs are not cheap.  The cheapest amount per year is $684 using the InHealth regular foam discs (one a day) and humidfilter (one a day).  On the high end at $2829 per year is Kapitex Neo-Naze baseplate (one a day) and Neo-Naze HME (one for the day and one at night).  You should be able to be reimbursed through your insurance company as these products are medically necessary for your pulmonary health.  You should request that the company send you the appropriate paperwork for reimbursement.  Ask your speech language pathologist or Ear, Nose and Throat Doctor to assist you with this paperwork.  The diagnosis codes they should use are 161.9 (cancer of the larynx), 784.41 (total laryngectomy) and 519 (complications from trach).  You should only have to fill this paperwork out one time.   

      When I was a child, I took dance lessons and for a few years did tap, acrobatic, and ballet routines, the kind that parents came to see at recitals.  I was not the star of the show but it probably helped me to get over some of the awkwardness of a 8 or 9 year old.  When I was in high school, I was in acting class and in the senior play.  That helped me to be less  shy in front of an audience.  Twice more, as my life went on, I was in an acting group, one a little theatre group in Clearwater, FL and the other a theatre-in-the-round group in Chicago, IL. 

     To skip down many years, I was divorced and had joined Parents Without Partners and became the VP of Education for the group in Birmingham, AL.  I arranged speakers for the meetings, planned the topics, leaders and locations for discussion groups, and filled in as speaker or discussion leader when necessary.  I did public speaking about the group and was on radio and TV occasionally.  After about 10 years, I moved out away from town and backed off from doing something that was just routine by this time. 

     After I retired at 62, I went back to an early love, acting, and joined a group called Seasoned Performers. We took a portable set and show around to schools, nursing homes and retirement communities.  I also joined the Radio Reading group here to read the newspaper for the blind once a week.  My retirement was fun while it lasted, but recovering from cancer soon became my new full time job.

      During all of those years, I had some creative activities, but nothing prepared me for my next one.  Writing?  No way!  I hated even the act of writing and it started with penmanship.  That was the only subject in grammar school where I earned steady Ps, for Poor, on my report card.  Reading was a snap and I read well before I ever started school, but even my mother, who loved me, would have had trouble justifying how difficult it was to get me to write a letter.

      Skip to about 6 months after my second cancer, the one that took my original voice.  I was asked to start a newsletter for our ?Head and Neck? cancer support group?just a little something to send out with the notice of the meeting every month.  So, for the first time in my life, I starting writing to try to teach my friends and fellow laryngectomees something about what happened to us and what we could do about it.  I collected hints and asked people to tell their story.  

     I used my PWP experience in recruiting people to write and promised the inexperienced authors that I would not let them look foolish, so I became an editor, using my whole life?s reading experience.  I read and re-read and made suggestions. When I had to stop and go back to realize what was meant by a phrase I knew it wasn?t coming through right and that it was out of order or confusing. I learned to cut through the nonsense words and peel away the fillers so what they wanted to say would be clear and easily understood. 

     We are not perfect and never will be, but what a pleasure to learn at an advanced age that you have untapped resources.