November 2003


Name Of Column Author Title Article Type
VoicePoints Lynn Acton, MS, CCC/SLP Heat & Moisture After Laryngectomy Education-Med
Bits, Buts, & Bytes Dutch Computer Tips Experiences
Roger's Ramblings Roger Jordan Tailor The Argument Experiences
Handy Hints WW  Members Hints For A Lary Experiences
News, Views, & Plain Talk Pat Sanders Sometimes You Follow A New Path Experiences
Musings From The President Murray Allan Food For Thought News & Events
Welcome New Members Listing Welcome News & Events

 


 VoicePoints
  
  coordinated by   Dr. Dan Kelly, Associate Professor ( dy_kelly@msn.com )
                                Department of Otolaryngology, Head & Neck Surgery
                                7700 University Court, Suite 3900, West Chester, OH  45069

[ ? 2003 Lynn Acton, M.S. ]

THE IMPORTANCE OF HEAT AND MOISTURE EXCHANGE AFTER LARYNGECTOMY


By Lynn Acton, MS, CCC/SLP, Speech-Language Pathologist
Yale-New Haven Hospital, New Haven, CT 06504
Email:
lynn.acton@yale.edu

            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.   


Inhealth Technologies-Humidifilter


ATOS-Provox Stomafilter System


Kapitex Healtcare Ltd has the Neo-Naze

 

                            Dutch's Bits, Buts, & Bytes
 
    (1)  The Google Calculator - Our first stop this month is kind of "geeky."  Well, no ... to tell the truth it is *REALLY* geeky.  Really *REALLY* geeky.  But it is a cool kind of geeky.
     Google now has a built-in calculator!  No, really!  Go to Google.com and instead of keying in a word or search phrase, key in a math problem like  2 + 2 or  72 / 3 and Google will automatically show you the answer!  That in an of itself is cool (and geeky), but Google's calculator will also solve simple, non-variable algebra and trigonometry problems like 4^2 + 7 and cosine (75 degrees).  That little pointy thingy -- the ^ -- is called a carat, and it is used in ASCII to signify exponents.  So 4^2 is actually four squared.
     And, if that isn't geeky enough for you, Google's calculator also has a built-in unit converter.  For example, try keying in  0b1111 in hex or 100 feet in astronomical units
     Neat, huh?  According to Google, "The calculator can evaluate mathematical expressions involving basic arithmetic (5+2*2 or 2^20), more complicated math (sine(30 degrees) or e^(i pi)+1), units of measure and conversions (100 miles in kilometers or 160 pounds * 4000 feet in Calories), and physical constants (1 a.u./c or G*mass of earth/radius of earth^2). You can also experiment with other numbering systems, including hexadecimal and binary."
     To prove once and for all that your fearless WebMaster has no social life and entirely too much free time on his hands, here are just a few of my favorite Google calculator searches:
     speed of light in knots
     5 smoot - 2 angstroms
     1.21 GW / 88 MPH
     Answer to life the universe and everything

(2)  Another neat Google Option: Dictionary Definitions   To use Google to find dictionary definitions, enter your query into the search box as you would normally. Any or all parts of your query for which they have a dictionary definition will be underlined in the center text above their search results, as seen for the query "search" in the following example:

example:   Searched the web for search.  Results 1 - 10 of about 227,000,000. Search took 0.08 seconds.

Clicking on the link will take you to the relevant definition from a dictionary provider, which has been selected solely on the basis of its quality.

(3)  Ever wonder what the differences are between the two major "browsers" --- Internet Explorer and Netscape?  Below is perhaps one of the better explanations: http://www.lib.berkeley.edu/TeachingLib/Guides/Internet/Browsers.html

(4)  "Shoot the Messenger"   Of Interest To: Windows NT, 2000, XP, and 2003 users in all countries!!

Back in the days of mainframe computing, and *WAY* before the days of instant messaging as we know it, the folks at computer centers needed a way to send emergency text messages to everyone announcing things like

     THE PRINT CENTER CLOSES IN 15 MINUTES!  PLEASE PICK UP YOUR PRINT JOBS IMMEDIATELY.
or
     SQUADRONS OF SQUIRRELS SPOTTED IN THE VICINITY OF THE SEEBECK COMPUTER CENTER!  YOU WOULD BE WISE TO IMMEDIATELY SAVE YOUR WORK AS WE WILL SOON BE PLUNGED INTO SQUIRREL-INDUCED DARKNESS.

So, built into mainframe operating systems like VM/CMS and UNIX are commands like TELL and WRITE that let you broadcast a simple text message to a specific user or group of users.  [And you get special karma points if you ever used these commands to spook newbies.]

Windows has a similar, built-in feature called the "Windows Messenger Service."  Now this is NOT to be confused with "Microsoft Messenger" or "MSN Messenger," Microsoft's free instant messaging program (a la AOL Instant Messenger, ICQ, or IRC.)  *WINDOWS* Messenger Service is a way for mainframe and network administrators to broadcast an emergency text message to all users.

The Windows Messenger Service is, by default, enabled in Windows NT, Windows 2000, Windows XP (Home and Professional), and Windows 2003.

And it's about as useless as giving a job application to my ex-brother-in-law! :-)

The problem is that the Windows Messenger Service can be used by unscrupulous spammers to send you an untraceable pop-up message even if your Internet Explorer is closed.  And, even worse, a hacker can use the Windows Messenger Service to break into your computer and do all sort of nasty things "including installing programs, viewing, changing or deleting data, or creating new accounts with full privileges."  [Source: Microsoft Security Bulletin MS03-043 at http://tinyurl.com/r2j3]

By the way, you DON'T need to worry about the Windows Messenger Service if have a Mac, a *nix box, Windows 95, Windows 98, Windows 98SE, or Windows ME.  BUT, if you have Windows NT, Windows 2000, Windows XP, and Windows 2003, you need to turn this little bugger off. Now!!

You could manually disable the Windows Messenger Service if you want -- the University of Virginia's Information Technology and Communications department shows you how to disable it at http://www.itc.virginia.edu/desktop/docs/messagepopup/  -- but if I were you I'd just hop on over to

     http://grc.com/stm/shootthemessenger.htm

and download the free "Shoot the Messenger" program.  I *HIGHLY* recommend this program for four reasons:

1. It's free.  Free is good.

2. The Shoot the Messenger program is only 22 kilobytes in size. That's so small it's downright silly.  You can download this program literally faster than you can read this sentence, even on the slowest modem connection on earth.

3. Shoot the Messenger was created by Steve Gibson at Gibson Research, the guy behind ShieldsUp and SpinRite.  Steve is probably one of the most trusted and respected computer gurus on the planet.  Having Steve Gibson [through his Shoot the Messenger program] disable the Windows Messenger Service for you is like having Lance Armstrong fix your bike or Mr. Goodwrench fix your car.

4. Downloading and running Shoot the Messenger keeps you from having to get your hands dirty (or mind boggled) by going to Start > Settings > Control Panel > Administrative Tools > Services > Messenger ...blah blah blah.

Once you have downloaded Shoot the Messenger, just locate the downloaded file on your computer and double-click on the "shootthemessenger.exe" icon or the downloaded file itself.  A little window appears telling you if the Windows Messenger Service is running on your computer.  If it is, just click on the "Disable Messenger" button and then click on "Exit."

That's it.  The Windows Messenger Service is now disabled, and your computer is now protected from both the spammers and the hackers who have been using the Windows Messenger Service to do nasty things to other people's computers.  The file can also "reactivate" the service, should you so desire (but WHY, I would not know).

Oh, and you can delete "shootthemessenger.exe" if you want.  You don't need it any more.  :) You might give it a try!!

Note: #4 above courtesy of the Internet Tourbus at: http://www.TOURBUS.com 
 




 Roger's Ramblings
  
                                                                                                                   by Roger Jordan (Laryngectomy - 1993)
 


   
I know that attorneys are rather low on the list of esteemed professions, but hope that since I am retired, I can call on my experience as an attorney without recrimination.  One of the most important lessons I learned in years of arguing cases before both judges and juries, was to tailor the argument to the audience.  I apply this lesson when talking to groups about smoking by speaking to what would motivate the audience, not what motivated me. 

    Most of us are in at least our 50's, some well into our 90's.  As such, we are motivated by health concerns.  I often begin lectures to older groups by stating that I tried unsuccessfully for many years to quit smoking until I heard the magic formula announced by my physician.  "You have cancer of the throat and will die in 6 months if you don't quit smoking."  I began cutting back, but didn't quit completely until my surgery, so while not strictly true, it does get the attention of older groups concerned with health. BUT, it is totally ineffective when speaking to school groups. They consider themselves immortal, and can't conceive of being my age, or even wanting to be   

    They are motivated by COOL. They want, above all else, to appear COOL. So I tell them how un-cool smoking is. I mention, for example, that when pulling up to a stop light, I look at the cars next to me. If the car is a new BMW or Porsche convertible, you will never see a cigarette in that car. But if the car is a ten year old clunker with only 3 fenders, all of different colors, you will nearly always see hands hanging out of the windows holding cigarettes. Walk in any mall, people inside are a mix of nicely dressed and slobs. But those smoking at the entrance are never well dressed. They are always slobs. Maybe they have to be unwashed slobs to overlook the stink of smoke with which they are surrounded. I remember when I first met my friend, Joy, I was still smoking and she hated it. Among other wise things she told me, was how she had quit smoking. She had been employed in a large mall in New Orleans and would go to the food court on break. Smoking was still allowed in most malls in those days. She noticed the dress and behavior of the smokers was completely unattractive compared to the non smokers. The contrast was so obvious that she determined that she didn't want to be associated by example with the smokers. It was her motivation to quit. Fortunately, she also was motivated to help me quit when we met several years later, rather than totally ignoring my overtures. But even with her help, I needed the MD'S warning followed by surgery.

    I mention how much smoking costs. $4.00 a day is a minimum figure. It can go to $6.00 or $8.00 easily and rapidly. The middle figure works out to about $185.00 per month in direct costs. This can be the monthly payment on a decent car, one with matching fenders, and that car could just go up in smoke.

    When one adds in the indirect costs such as burned clothes, increased cost of medical insurance, accidents caused by dropped cigarettes, premature deaths due to, not just disease, but fires caused by falling asleep when smoking, then smoking makes even less sense.

    I once had to buy a new mattress for a motel when I fell asleep smoking. When I woke up, due to the heat of the burning mattress, the room was full of smoke. I remember that it was April 1, 1963. When I called the office to report the fire, the clerk laughed and said "April Fool". I smoked for another 30 years, so I guess I was a 12 month, not just an April, fool. Even what could have been my own death wasn't enough to motivate me to quit.

    It would have been much easier not to have started, even though at the time I started, not smoking was considered un-cool. Above all, it is much easier to get hooked on smoking than to quit. I know.


                               Hopefully Handy Hints
 

A GREAT IDEA FOR NECK COVERINGS

Years ago, when I had my total laryngectomy surgery, I was a hairdresser, who went back to work six weeks after discharge; I had to since I owned the salon. The coughing was embarrassing and I couldn't stop in the middle of a procedure so I found a solution I had a stainless steel chain cut to fit my neck just above the stoma and looped a 4x4 gauze pad over it. That way I could run in the back room and change it when necessary (I still wear one today).  It was sanitary, easy and unobtrusive. I was able to wear mock turtlenecks, scarves and necklaces. Fran Stark

HOLSTER FOR AN ARTIFICIAL LARYNX

You can purchase a "mace holder" at a police equipment store that will double as an AL holster. You can also purchase at sporting goods stores and gun shows, a "double clip" ammunition holster that will also work as an AL holster.  Put ?mace holder? in google.com and you will find them for $5.50 and up (see below).      Jim Lauder, Lauder Enterprises

HOLD UP ON PERFUMES AND HAIR SPRAYS (posted rules at a gymnasium)

For some of us, perfumes and sprays are just uncomfortable and we find it inconsiderate of the offender, but other people will actually have severe breathing problems triggered by heavy perfumes.  So, be considerate of others.  Not everyone wants to smell (and sometimes almost taste) your choice in perfumes.  What may be acceptable in the average workplace may not be acceptable where people are doing a lot of heavy and deep breathing.  Also, when primping after your workout, be aware of who's around when you spray deodorant or hairspray----no one likes to suck in your choice of scents in such a concentrated form.

(Editors note: For laryngectomees, these fumes go straight to the lungs!)




 News, Views, & Plain Talk
  
                                                               by Pat Wertz Sanders, WebWhispers VP - Web Information
 

Sometimes You Follow a New Path

      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. 

     Almost nine years of HeadLines are on the WebWhispers site and you will find knowledgeable articles from a huge mix of people, many of whom have never written for anyone else.  I accept and am grateful for articles that you might contribute and you may send them to pat@choralmusic.com  

     In addition, Whispers on the Web, the monthly newsletter for WebWhispers, takes submissions at
editor@webwhispers.org, where Dutch and I work together as managing editors.  Give it a try.  You may find a whole new world of expression and communication.




                Murray's Mumbles ... Musings from the President
 
     FOOD FOR THOUGHT?
 
     ARE WE COMMUNICATING??  A man spoke frantically into the phone, "My wife is pregnant and her contractions are only two minutes apart!" "Is this her first child?" the doctor asked. "No!"  the man shouted, "This is her husband!"
 
     The twelve most persuasive words in the English language, according to a recent Yale study are: You, money, save, new, easy, free, guarantee. love, discovery, results ,health and proven.
 
THE CHINA SYNDROME
 
    98.5 per cent of all shoes sold in the United States are made overseas, most of them in China.
 
    China makes about three-quarters of the world's toys in its more than 10,000 toy factories.
 
    China has more English speakers than the United States.
 
WELCOME TO ALL!
 
    Welcome to all our new laryngectomees, caregivers and professionals this month.  I know that all the "newbies" will gain a wealth of knowledge from this site and from all of those that have gone before them.
 
    Should you have any suggestions or constructive criticism please contact Pat or Dutch at Editor@WebWhispers.org.
 
Kindest regards,
 
Murray Allan
President, WebWhispers Nu-Voice Club


   ListServ "Flame Warriors"   


                                                                                Terms of Importance
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) ...

COFFEE KLATCH

For Coffee Klatch the discussion forum is a social gathering - like Mah Jong or the Wednesday
morning canasta club.  Coffee Klatch prefers a friendly, chatty environment and almost always
limits her participation to non-technical forums.  Whether inadvertently or by design, Coffee Klatch
 prepares the battlefield in her favor by making it soggy with pleasant, but vapid messages  
  - her favorite phrase often being, "thanks for sharing".  This renders the battlefield rather slow going   
for many of the swifter and more powerful Warriors, and if war does break out she will shed her
benign facade and strike mired Warriors with great ferocity.

Above courtesy of Mike Reed
See more of his work at: http://www.winternet.com/~mikelr/flame1.html 
 
 

   Welcome To Our New Members   

     We welcome the 13 new members who joined us during October 2003:

Danny Biddle
Albion, IN
Sal & Kay Cefali
Oviedo, FL
Donna Christensen - SLP
Stevens Point, WI
Kim Holmes - Caregiver
Robbinsdale, MN
Gary Huffaker
Austin, TX
Sandra Palmer
Cortland, OH
Richard W. Powell
Brainerd, MN
Jeff Searl - SLP
Bowling Green, OH
Lee Skipwith
St. Petersburg, FL
Heather Starmer - SLP
Pittsburgh, PA
Lew Watnick
Thousand Oaks, CA
Steven Whitmore
Hamilton, OH
  Marion Yaros
Bradenton, FL
 


   Happy Thanksgiving  
27 November 2003
 



 
WebWhispers is an Internet-based laryngectomee support group.
  It is a member of the International Association of Laryngectomees.        
  The current officers are:
  Murray Allan..............................President
  Pat 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   

 

Disclaimer:
The information offered via the WebWhispers Nu-Voice Club and in
http://www.webwhispers.org 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.



As a charitable organization, as described in IRS § 501(c)(3), the WebWhispers Nu-Voice Club
is eligible to receive tax-deductible contributions in accordance with IRS § 170.



  ? 2003 WebWhispers
Reprinting/Copying Instructions
can be found on our
WotW/Journal Page.