|Name Of Column
||Lynn Acton, MS, CCC/SLP
||Heat & Moisture After Laryngectomy
|Bits, Buts, & Bytes
||Tailor The Argument
||Hints For A Lary
|News, Views, & Plain Talk
||Sometimes You Follow A New Path
|Musings From The President
||Food For Thought
||News & Events
|Welcome New Members
||News & Events
coordinated by Dr. Dan Kelly, Associate Professor
( firstname.lastname@example.org )
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
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.
ATOS-Provox Stomafilter System
Kapitex Healtcare Ltd
has the Neo-Naze
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
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:
the web for
search. Results 1 - 10 of about 227,000,000. Search took 0.08
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
(3) Ever wonder what the differences are between the two major
"browsers" --- Internet Explorer and Netscape? Below is perhaps one of
the better explanations:
(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
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
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
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
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
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:
by Roger Jordan
(Laryngectomy - 1993)
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.
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
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
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
Hopefully Handy Hints
A GREAT IDEA FOR NECK
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
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
(Editors note: For
laryngectomees, these fumes go straight to the lungs!)
Views, & Plain Talk
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.
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
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
We are not perfect and never will be, but what a pleasure to learn
at an advanced age that you have untapped resources.
In addition, Whispers on the Web, the monthly newsletter for
WebWhispers, takes submissions at
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?
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
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.
cent of all shoes sold in the United States are made overseas, most of them
about three-quarters of the world's toys in its more than 10,000 toy
more English speakers than the United States.
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.
have any suggestions or constructive criticism please contact Pat or Dutch
WebWhispers Nu-Voice Club
ListServ "Flame Warriors"
Terms of Importance
1. n. A hostile, often unprovoked, message directed at a participant of an
The content of the message typically disparages the intelligence, sanity,
or ancestry of the recipient.
2. v. The act of sending a hostile message on the internet.
1. n. One who actively flames, or willingly participates in a flame war ...
(Another Example Below) ...
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
and strike mired Warriors with great ferocity.
Above courtesy of Mike Reed
See more of his work at: