November 2005


 

 

Name Of Column Author Title Article Type
Musings From The President Murray Allan Profile Of Dutch News & Events
Web Whispers Columnist Marianne Peereboom Dutch Assn Larys Experiences
VoicePoints Dr. Jeff Searl ES Speech Today Education-Med
News You Can Use Scott Bachman Maintain Your Records Experiences
Living The Lary Lifestyle Joan G. Burnside  Chapter 9 Education-Med
Between Friends          Donna McGary Look Inward Experiences
Roger's Ramblings Roger Jordan Katrina Experiences
Bits, Buts, & Bytes Dutch Computer Tips Experiences
New Members Listing Welcome News & Events

 

 

                Murray's Mumbles ... Musings from the President
 
                     Profile of a WebWhispers Executive Committee Member
 

Having profiled Pat Sanders, Terry Duga, and Libby Fitzgerald it is now time to mention the man that made WebWhispers possible.  I can say without reservation that without him you would not be reading this now.  Our Founder is, of course, Lt. Col. David L. Helms, USAF, (Ret.) but he is known to one and all as "Dutch".  He is also the WebWhispers Vice-President - Internet Activities and the permanent Webmaster "until fired" as he likes to say.  Additionally, he was the first winner of our prestigious Casey-Cooper Laryngectomee of the Year award in 2001.
 
Dutch joined the rolls of laryngectomees in 1994.  Prior to that his life had been full of activities that required a "normal" speaking voice.  He was born and raised near Cleveland, Ohio; received his BA in German and History from Heidelberg College and after limited graduate work at Ohio and Oklahoma Universities finally received his MA in National Security Affairs from the Naval Postgraduate School in Monterey, CA.  He was primarily a military pilot, a Vietnam veteran who flew 339 combat/
combat-reconnaissance missions as an O-2A Forward Air Controller (FAC) in support of the 101st Airborne Division and was twice awarded the Distinguished Flying Cross for his efforts.  He was later an instructor pilot in the T-37 and T-38 aircraft, crewed the F-4E "Phantom II", and flew the F-104G with the German Air Force.  Dutch was also a military air attache', a narrator, teacher, emcee for various events, and even sang in choirs, choruses and barbershop quartets.  His entire life had revolved around the use of his natural voice, perhaps more than many of us.  The loss of it was devastating and the thought of never being able to do these things again was totally beyond his imagination.
 
I believe that the real mark of a person is to be able to tell the truth even though it may cause some personal embarrassment.  Dutch once wrote, " I simply could not imagine going through life without a VOICE.  Thus, being told that a laryngectomy would be necessary, while I was still suffering from going through a divorce and having the next relationship end with a canceled wedding, really shocked my whole system.  Lacking the nearby support of family and friends, this drove me deep into depression and to near suicide.  I simply couldn't think of a reason to live.  Luckily I got help and spent over a month in a military mental health facility "getting a grip on life" again.  Afterwards, I pressed ahead with treatments and finally the laryngectomy." 
 
I believe that many of us would be inclined to not mention that part as it may tend to show a personal weakness to some.   This didn't bother Dutch.  He told the truth, the whole truth and nothing but the truth and that's  the mark of Dutch Helms.  And his honesty, steadfastness, and integrity show through in all the things he has done in his work to create the beginnings of WebWhispers in 1996 with a small group of laryngectomees. 
 
In 1998 WebWhispers was officially off the ground with an elected Executive Committee and the word spread and the larys came.  In just a few years this web site had more than 1200 members including, larys, caregivers and professionals.
 
Dutch, through WebWhispers, has inspired countless numbers of individuals battling this devastating disease.  He has made hundreds of cyber space friends and now as permanent Webmaster works tirelessly and relentlessly to supply the needed information, support, and guidance to those initially diagnosed with laryngeal cancer and to those living life as a laryngectomee.
 
Dutch has his home in El Lago, Texas, southeast of Houston near Johnson Space Center, where, in addition to THE computer, he has many hobbies including the delicate work of hand crafting 54mm military miniatures (what some erroneously call "toy soldiers").  His first love, of course, is WebWhispers and the amount of time and effort he has spent organizing it and operating it every day is truly amazing. 

Dutch, we are very proud of you and as they say in Texas, "thanks much!".
 
BREAKING NEWS FROM THE IAL:

IAL 2006 will be held 19-22 July at the Hyatt Regency - Woodfield, Schaumburg, Illinois (Chicago area).  Details will be available later on the IAL web site.

I wish you all the very best of everything.
 
Take care and stay well.
 
Murray Allan
argus@shaw.ca

 

 

   WebWhispers Columnist
                                                                                  
Contribution from a Member
 

 
How we celebrate our annual day with
THE DUTCH ASSOCIATION OF LARYNGECTOMEES
by Marianne Peereboom, Nibbixwoud, NL

NSvG, the Dutch Association of Laryngectomees has our annual day every year in October.  The day starts with coffee and cake, then has an official part which is never more then one and a half hour.  Sometimes we have a speaker but this year we had the promotion video of the lary swim clubs (2) we have here in The Netherlands.  Lunch is a buffet and dessert is served on the tables.

Our association is built up of 10 voice clubs which all come together under the Mother.  Each voice club covers a part of the Netherlands.  Every year is a new theme and this year it was meet and get to know each other.  We were asked to promote the area where our own club is located to show the others what goes on in our area, what grows there, what the specialities are (like food or candy), buildings, history, or whatever else we wanted to tell about.   We could show them famous buildings or other things of the area people might know about.

Each voice club had their own booth to use for doing this and it was amazing what came out.  One booth was of people from the South West of The Netherlands, which is famous for shrimp and fish.  One lady was all dressed up in the costume they wear there and she was peeling the shrimp.  Another booth of a club of the North showed the famous 11 cities skate tour, had sausage and candy they make there.  Another one has a city in the area which is the oldest city in the Netherlands.  Their city came from a Roman army camp thousands of years ago.  They built a Roman gate and were dressed up as Roman soldiers.

Our area is famous because of the cheese (Edam), tulip bulbs, sauerkraut they make here and the cabbage they grow on the land.  This area also has many windmills, the beach on one side and the lake on the other.  We have the Dutch navy with the harbor and many old cities, older than Amsterdam. There is a lot of culture in my area.  We also have two villages Volendam and Marken where people still wear the traditional clothing. My husband was born and raised on Marken and his family still lives there.

My Mother in law has shelves full of clothes and she helped me to get my outfit.  What I am wearing in the photo is the summer outfit but there are many more versions.  Most of this clothing is very old, some even more than two hundred years and it goes from mother to daughter.  They have a costume for the time of the year, when you get married, because someone passed away in the family and even that goes in stages.  I have not had real Marken traditional clothing on for 23 years.  Last time was when our marriage was announced in church, 2 weeks before we got married in 1982.

To get the people to the booth area ( the market as we called it) every booth had a question the people had to answer.  The booths had a number and were not marked where they came from so the people had to guess what the clue was and where the people came from because of the way the booth was set up.  I was dressed in this clothing and people had to guess that.  In another booth they had to guess what kind of a fishing net it was, how many candies ( special) were in the bowl, how much the cookies ( special) had cost and so on.  It was a huge hit, there where 365 people at the meeting and almost 200 had sent in the form. The person who had the most right answers had a prize and also the second and third runner up.  Also, the best looking booth according to a jury won a prize.

My buddies and I spent a lot of time getting the stuff together.  We have so many cultural things in the area, we had to make choices.  If we had used names of cities, then people would know right away.  We used pictures of statues, posters, flower bulbs to hand out, we had Navy Uniforms on a puppet, we had a model of a flat bottom ship that fishermen used.  We had buckets and bags with sauerkraut, different kinds of cabbage, we showed the sea and the dunes that protect us ( we live at least 3 meters under sea level).  We got a lot of information and DVD?s of the company that makes the plans to protect us from the sea.  They built up the dunes, bringing in dams to guide the water another way so it won't wash away the beaches.

We had a windmill model, an old model of a train that used to run from one city to another but now serves as a tourist attraction and we handed out 8 pounds of Edam cheese.  We also had a model of a ship that farmers used in the early days to bring potatoes, cabbage and other veggies to the place where they sold it.  This was an auction place and they brought it all in by ship.  The water went through the building so the ships came in, the people bought the stuff, they unloaded it on the other side and out they went again.  This was VERY special for me because my Grandfather used to come to this place and, as little girl, I had been there with him.  I must have been 3 or 4 years old but I still remember it.  The place is still there and is a museum now where people still can buy things.  We got pictures of the old days and one of them had my Grandfather on it.  Almost everything we had in the booth was given to us by either companies (bulbs and sauerkraut) or museums and people loaned us their models of old Dutch houses and the Navy uniforms.  We only bought the cheese and the sand for the dunes.

I also sent in a picture of my two children dressed up in traditional Marker clothing.  My son wears the male outfit that adult men wear.  My daughter is wearing the clothes that girls use to wear when they were getting married but this particular outfit is at least 200 years old and people were a lot smaller then so we needed to dress her up before she was too grown up.  Small details on her and my clothes, there is not a button on it.  Everything is held together by hooks and eyes, pins and strings.

This lovely day was gone in no time and it was a great success.  People got to meet and talk to each other, got out of their chairs and walked around and, in the end, we were running out of time with so much to see.

 


 

 VoicePoints [ ? 2005 Dr. Jeff Searl ]
  
  coordinated by  Dr. Jeff Searl, Associate Professor ( jsearl@kumc.edu )
                               Hearing and Speech Department, The University of Kansas Medical Center
                               MS3039, 3901 Rainbow Blvd., Kansas City, KS 66160

Esophageal Speech Today
Jeff Searl
University of Kansas Medical Center

 

        Two events served as the impetus for the review that follows. The first was a referral of a laryngectomy patient. The second was my reading of an article that is now 13 years old. Bear with the long introduction that sets up the more academic review that follows.
 
        I received a referral six weeks ago from one of our ENTs asking me to see a 49 year-old woman, ?Doris,? who had undergone a laryngectomy nearly two years. I had to read the doctors order twice to make sure of what I was seeing. Somewhat to my surprise, the request was specifically for esophageal speech training. While I was elated to take on such a case, I was also surprised. Like many speech-language pathologists (SLPs) these days who work with post-laryngectomy individuals, most of my time is spent with folks that use a tracheoesophageal (TE) voice prosthesis or an artificial larynx (AL). As it turns out, esophageal speech was not this woman?s initial choice for a communication option but, to be honest, she really had no idea what esophageal speech was. This lack of knowledge about esophageal speech is not unique among the newly laryngectomized who most often seem to be told more about TE and AL speech than ES (although this is not universally the case). In general, we (I, and other SLPs) may not be doing a particularly good job at:

1) laying out all three of the primary alaryngeal speech communication options in an unbiased way, and
2) being ready to actually offer training in any or all of the three options.

        At about the same time that Doris was referred to me, I happened across an article from 1992 titled, ?Primary Tracheoesophageal Puncture vs. Esophageal Speech? by Quer, Burgues-Villa and Garcia-Crespillo (published in the Archives of Otolaryngology-Head&Neck Surgery). As it turned out, this article was intimately linked to Doris? situation. In the article, the authors were asking: If given a choice, what alaryngeal voice option would patients prefer,  TE or esophageal? There are other studies that ask patients (and others) their preferences for the different alaryngeal communication options. In these other studies, subjects are usually presented with different scenarios or audio samples of voices and then asked which they prefer. Or alternatively, studies will ask a group of TE speakers how well they are doing in their life, how good they think their speech is ,etc.; then, do the same with a group of AL users or esophageal speakers and compare responses. In the study by Quer and colleagues, the patients were actually allowed the opportunity to become proficient at TE and then trained to the best of their ability to use esophageal speech. Of their 23 TE speakers who were also trained to use esophageal speech, 16 decided to remove their TE prosthesis at the conclusion of the study, opting for esophageal speech. This represents 70% of the group. The really interesting thing was that this group that switched to esophageal speech indicated that their TE voice was better than there esophageal one  but they still preferred to use esophageal speech.

        Back to Doris for a moment. When she came to me, she wasn?t sure she wanted to learn esophageal speech. She hardly knew anything about it. In her case, she had a TE puncture done as a secondary procedure about 18 months prior to seeing me (she used an AL, pre-puncture). She had actually been successful at using her TE voice for several months. However, the tissues of her neck started to do some funny things. Her TE fistula tract migrated down so that it eventually was about 1 ? inches below the lower rim of the stoma. This, of course, made care of her indwelling prosthesis nearly impossible. Her stoma also started to shift to the left side of the neck. And she had persistent problems with stoma shrinkage (she?d had two stoma revisions to increase the size to no avail and used a laryngectomy tube to stent the stoma at night and at times during the day). Her neck tissue was not stable. The prosthesis was pulled and the fistula tract allowed to heal in the hopes of later re-puncturing in a better location that would allow changing and care of the prosthesis.

        When she showed up at my doorstep, she was using an AL (and not very well at that!) placed on the left cheek. Radiation changes and significant keloid scarring on the neck made neck placement untenable for getting good AL resonance. She had lukewarm interest in esophageal speech after I explained it to her, but she was willing to try. She also needed work on cleaning up her AL use so I offered her that as well. As it turns out, she is wonderful at esophageal speech, not proficient yet but a quick study, who I have every hope will eventually be able to utilize ES at her whim. Ten days ago, Doris had a routine follow-up with her ENT and I was able to go to that visit with her. Her neck tissue has settled down now and re-puncturing is a possibility in a few more months according to her ENT, if Doris is interested. She?s not sure if she is. Doris is a real-life situation of the study by Quer and colleagues. She has an opportunity that very few patients get in that she will have had an opportunity to know what it is like to actually use esophageal speech, TE speech, and artificial larynx speech. Most of the folks I work with might get the chance to compare TE and AL use because we train all of our folks on an AL. Now I am starting to wonder how we can incorporate a true esophageal speech learning experience into the mix in order to get a truly informed decision on the part of the patient.

        What follows are some reflections on esophageal speech and its changing role in countries in which Western medical practices dominate and TE speech is often considered the standard of care. I recognize that there is a risk of sounding ?anti? TE or ?anti? AL in what follows. That is not the intent at all. TE speech has revolutionized the rehabilitation of individuals who undergo total laryngectomy. I do most of my clinical work and much of my research on TE (and AL) speakers. And I, like others, recognize the significant advantages that TE speech has (although there are disadvantages as well) over esophageal and AL speech. However, the SLP has an obligation to present the advantages and disadvantages of each option, evaluate each patient?s abilities and needs, and seek the patient?s preference when deciding on an alaryngeal communication option. The SLP also should recognize that a patient?s abilities, needs, and preferences can change over time just as they did for Doris and the subjects in the study by Quer and colleagues.

        In a VoicePoints column, March 2005 (ref #42), Jim Shanks provided an excellent description of esophageal speech. He alluded to the fact that this method of alaryngeal speech is becoming less and less utilized. In some respects, this is a follow-up to Jim?s thoughts. This not a call for preserving esophageal speech like a relic in a museum. Rather, it is a call to question whether there is a reason to revive interest in esophageal speech as a true option for our patients with a laryngectomy. It has remained that in some locations, but not many. As indicated below, it seems likely that as a prior generation of SLPs trained to offer esophageal speech instruction retires, there will be fewer professionals knowledgeable about esophageal speech and even fewer capable of offering the service to clients. The catch is that laryngectomee speakers who utilize esophageal speech have historically served a role in training other laryngectomees in this method. As fewer and fewer laryngectomees utilize esophageal speech, opting instead for AL or TE speech, the pool of potential laryngectomee trainers also decreases.

Esophageal Speech in the Context of Western Medicine

        The history of alaryngeal speech training is longer for both artificial larynx speech and esophageal speech relative to tracheoesophageal speech. However, the introduction of tracheoesophageal puncture (TEP) in the 1980?s (Singer and Blom, 1980) has led to a significant shift in post-laryngectomy speech rehabilitation. This has been particularly true in countries with predominantly Western medical practices. The increasing popularity of TE speech since its introduction is presumably related to several factors. Undoubtedly, the high success rate reported for re-establishing communication fairly quickly after surgery has had a major influence. There are many articles documenting the quick rate of acquisition of TE speech by a large percentage of folks that attempt it (see the following items in the reference list: #2-5). The high success rate for TE speech is in stark contrast to the relatively low acquisition rates for ES (refs #6-10).

        Despite the rise of TE speech as a viable communication option post-laryngectomy, it may not be the most appropriate or the preferred choice for all individuals. Gress (2004) indicated that in an ideal situation, patients are informed about the advantages, disadvantages, and pre-requisites of AL, ES, and TE speech. After discussion and evaluation of the patient, the method of communication that best meets the person?s needs and abilities is selected. Gress goes on to state, however, that the ideal situation is often not attained in practice for a variety of reasons. Issues such as the SLPs training, the ENTs preference for doing TE punctures (or not), and difficulty educating patients who have just received a diagnosis of cancer are just a few of these. We do know that the SLP and surgeon have a major role in shaping a laryngectomized patient?s expectations and attitudes toward the various alaryngeal speech options based on the way that they present them to patients (reference #12). Whether unwittingly or not, the biases that a healthcare professional has toward AL, ES, and TE speech could serve to restrict the post-surgical speech options that a patient knows about or pursues.

        In our clinic, we begin from the following premise: AL, ES, and TE speech are not pitted against one another with the goal of crowning one as more superior than the others. Rather, the clinician?s goal is to identify the most appropriate alaryngeal communication options for an individual based on that person?s abilities, needs, and preferences at a particular point in their recovery.

        Prior to the introduction of TEP in the early 1980?s (ref #1), ES played a prominent role in alaryngeal speech rehabilitation and was regarded as the ?gold standard? for many years. Artificial larynx speech was another option but a negative bias against AL use persisted. This has largely been refuted, and clinicians and patients alike generally see the merits of AL usage for many laryngectomees. Ironically, with greater acceptance of AL speech and the advent of TE speech as a highly successful third option, ES has become the least utilized of the alaryngeal speech modes in many countries with predominantly Western medical practice (refs#: 8, 13, 14). This is not necessarily the case for other locales wherein AL and ES have remained the primary options, with TE speech emerging as a lesser used method (refs #: 9, 15-17).

A Brief Review of Advantages and Disadvantages of Esophageal Speech

        Despite the reduction in popularity of ES as a communication option over the last 20-25 years, ES can be appropriate, and in some cases preferred, for certain individuals. The issue is in determining who these individuals are. Esophageal speech does offer advantages over AL and TEP speech that can be substantial. Specific advantages and disadvantages per mode are offered in Tables 1-3 at the end of this article. The tables are broken down into issues regarding how the speech is produced (Table 1), what the speech generally sounds like (Table 2), and then therapy and other issues (Table 3). The intent here is not to engage in detailed comparison across the three modes, but rather to highlight key issues.

        For some patients, ES may be selected as their primary mode of communication. These may be individuals who attempt ES because:
1) they find aspects of TE or AL speech objectionable enough to eliminate them from consideration,
2) they do not have the pre-requisites for either of the other options, or
3) ES has a particular advantage(s) that is powerful enough to make it the patient?s preferred choice.
For example, some individuals may object to the reliance on a mechanical device or prosthesis for voice production, preferring to rely solely on their own body to speak. This eliminates the worry of mechanical or prosthetic failures (. Other patients might not have the eye sight, manual dexterity, or a capable caregiver to assume daily cleaning and care for a TE valve. Still others might have tissue that does not allow a stable TE fistula (like Doris on her first TE puncture).
 
        Some individuals may opt to learn ES to serve as a supplement to either AL or TE  speech. For example, a TE or AL user may find it convenient to be able to produce words or short phrases using ES in select circumstances (e.g., quick social niceties such as ?thank you,? ?bye-bye?, etc.). Still others, may learn ES in recognition of the fact that sometimes AL and TE speech are problematic. For example, an AL user may find themselves with a broken device without a back-up. A TE user with a malfunctioning indwelling valve may be waiting for some period of time to get in to see the SLP. Whether it be a matter of days or only hours, all laryngectomy speakers should have a back-up means of communicating. Esophageal speech could serve that role.

        Scanning Tables 1-3, the advantages of ES mainly relate to ?how the speech is produced? (Table 1). Nothing other than the patient?s own body is required and there are no particular requirements as far as visual acuity or hand/arm control. For some individuals, the freedom to use both hands for other tasks while talking is particularly important, perhaps for their occupation or hobbies. Hands free speech is certainly possible with TE speech if a hands-free valve is used. However, this requires additional hardware with associated daily care that may be more than the patient wishes to take on.

        Esophageal speech does not fair nearly so well when we consider the research about ?how the speech sounds?. That is not to say that ES is a poor option. However, we do know that there are some limitations about esophageal speech that can be problematic, at least for some people or some situations. It should be kept in mind that ES is not the only alaryngeal communication option that falls short in terms of how it sounds. All three communication modes deviate from the speech of a non-laryngectomized person on just about any acoustic or perceptual measure. However, the research literature suggests that TE speech is generally regarded as being the most similar to laryngeal speech (refs#: 18-24). Additionally, the literature generally favors TE over AL and ES in terms of intelligibility (refs#24-28) and listener preference (refs#2, 27, 29; but see refs # 30-32 who found something to the contrary). Remember though, that these are results when we look at groups of speakers. We have many, many, folks who are excellent ES (and AL and TE) users. And we have poor speakers using each of the three options as well. Some research suggests that the overall intelligibility of the speech is more dependent on the individual rather than the alaryngeal communication option that is being used.

        The acoustic, perceptual and listener preference data should give clinicians reason to pause and ask: why consider ES (and AL) in light of the advantages of TE speech in terms of its superior voice? Some answers to this question are more obvious and have been alluded to above. Availability of ES and/or AL is necessary for individuals who do not meet the pre-requisites for TE voice production or who cannot tolerate any of the disadvantages associated with TE speech (ongoing costs, intermittent but ongoing reliance on SLP, etc.). Less obviously are indications from the literature that not all people who attempt TE speech are successful at using it. Initial success rates reported in the literature have ranged from ~30%-90%, although most have fallen toward the top half of this range (refs#: 5, 33-37). However, not all are successful at it, and the follow-up data suggest that perhaps 5% to 30% of individuals who had initial TEP success are not using TE speech at 9 months or more (refs#: 2, 35, 36, 38). The reasons for this might be many and it could be argued that with due diligence by the patient and rehabilitation team, the drop in success over time could be reduced. However, the consistent reports of less than 100% success and some drop-off in TE usage over time argue for the need to have other alaryngeal speech options available.

        Using TE speech acquisition rates to argue for maintaining ES as a viable third alaryngeal speech option is a risky proposition. The rate of successful acquisition of functional ES falls within the range from ~%5-60% (refs#: 8-10, 39, 40; but see refs# 15 and 41 who report higher rates). This is generally lower than even the long-term follow-up data for TE speech. In fact, the low success rates in acquiring ES were a major driving force behind the development of the TEP procedure. However, not all individuals can utilize TE speech and some individuals can learn ES (or AL).

        There is a final and valid consideration, alluded to above, regarding the relevance of ES in this era in which TE speech is often held out as the new standard of care. Some patients may seek out ES as a communication option not because they fail at or lack pre-requisites for TE or AL speech but simply may prefer ES. We have very little data available in which the various methods of communication are compared within the same speakers. The study by Quer, Burgues-Vila and Garcia-Crespillo that I mentioned in the introduction is intriguing. As they stated, they sought to answer the question: ?What type of voice rehabilitation would our patients prefer if they could make a choice between tracheoesophageal and esophageal speech?? (p.190). Seventy percent of there group opted for ES even though they felt like their TE voice was better. This suggests that at least some patients would make a decision on their preferred method based on more than just characteristics of the voice. Clinicians should do the same.
 
        One question of importance for which we do not have an answer is: How often do patients have a fully informed say about which communication option(s) they can utilize? Personal communications with SLPs across the United States in the past two years suggest that fewer and fewer clinicians are knowledgeable about ES and even fewer are comfortable training its use, even those who regularly treat individuals post-laryngectomy. If this trend is real and it continues, the chance that ES is offered as a truly viable communication option to patients will continue to decrease. More studies that allow patients to directly compare the three options and then chose their preferred method would go a long way toward directing the SLP field in terms of the emphasis that should be placed on ES research and training in the future. We agree with Doyle (2005): ?Clinicians must fight the urge to dismiss any of the post-laryngectomy communicative options presently available (esophageal, TE, and artificial laryngeal speech) without adequate cause? (p. 548). Esophageal speech will not be for everyone. In fact we know that many folks who set out to learn it are unable to do so, perhaps because of how the top of their esophagus functions after the surgery or for a variety of other reasons. Likewise though, TE and AL are not for everyone. Informed choice is ideal. Better yet would be the opportunity for an individual with a laryngectomy to actually experience each of the options in sufficient depth to inform their decision, although this will not always be feasible. As a researcher and clinician the challenge may be to figure out a way to better predict early on who is likely to succeed in learning esophageal speech. Perhaps we can delve into that topic more in a later column.



  Table 1. Comparison of artificial larynx, esophageal, and tracheoesophageal (TE) speech in terms of how the speech is produced.

 

Speech Process Issues Artificial Larynx Speech Esophageal Speech TE Speech

Mechanical Device/Prosthetic Required

 

Yes No Yes

Hand Occupied During Voicing

 

Yes No

Yes/ No
(some are able to use a hands-free speaking valve)

 

Interference with Oral Movements

 

Yes/No
(use of an oral adaptor can cause interference)
No No
Visual Acuity Requirement

No special requirement

 


(reduced visual acuity can generally be tolerated)

No special requirement

 

Voice Production: No special  requirement usually needed
Prosthesis Care: May need caregiver support if visual acuity is reduced

 

Finger/Hand/Arm Dexterity Requirement

Requires ability to hold, activate, and manipulate device controls (use of within-the-oral-cavity devices can mitigate this requirement)

   No special requirement

Voice Production: Requires ability to manually occlude stoma unless using a hands-free valve (which itself, requires fine motor control for attachment)
Prosthesis Care: Fine motor control needed unless caregiver

 

     assumes the duty

 

  Table 2. Comparison of artificial larynx, esophageal, and tracheoesophageal speech in terms of how the speech sounds.

 

Speech Product Issues Artificial Larynx Speech Esophageal Speech TE Speech
Voice quality
1, 2, 3, 4, 5
Mechanical/unnatural; less preferred than laryngeal; generally less preferred quality than ES or TE Glottal fry, hoarse, rough, wet, breathy; less preferred than laryngeal and TE Glottal fry, hoarse, rough, wet, breathy; generally, less deviant than ES and EL, but less preferred than laryngeal
Speaking Fundamental Frequency Mean
6, 7, 8, 9, 10
Determined by device used ? some are adjustable Lower than TES and laryngeal speakers

Lower than laryngeal speakers, but not as low as ES

Intonation/pitch variability
11, 12, 13, 14, 15

Restricted primarily by the device used Restricted relative to laryngeal and TEP; greater than EL Restricted relative to laryngeal; greater than ES and EL

Speaking Intensity
Mean

3, 6, 9, 16, 17, 18, 19

Adjustable ? potentially louder than ES, TES and laryngeal speech Less intense than laryngeal, EL and TEP Variable from less than, equal to, to greater than laryngeal; greater than ES
Speaking Rate
9, 20, 21, 22
Equal to/possibly faster than laryngeal, ES and TEP Slower than laryngeal, EL, and TEP Comparable to laryngeal; faster than ES
Speech Intelligibility
23, 24, 25, 26, 27
Less than laryngeal, TE and ES in high signal-noise situations
Higher than TE and ES in Noise
Less than laryngeal and TE, generally Less than laryngeal; Greater than ES and EL (except in noise?)
Overall "success" in attaining useable speech
25, 28, 29, 30, 31, 32, 33
Generally, a fairly high success rate (large percentage of users) Generally considered to have the lowest of the three Typically higher than ES; also higher than EL (?)

 

                              1Merwin, Goldstein and Rothman (1985)                              12Salmon (1999)                                         23Clark (1985)
                              2Beudin, Meltzman, Doyle & Hillman (2004)                       13Bennett & Weinberg (1973)                    24Damste (1975)
                              3Clark & Stemple (1982)                                                        14Martin & Wiig (1980)                             25Hillman, Walsh, Wolf, Fisher & Hong (1998)
                              4Tardy-Mitzell, Andrews & Bowman (1985)                        15Trudeau (1994)                                       26Blom et al. (1986)
                              5Trudeau (1987)                                                                      16Smith, Weinberg & Horii (1980)             27Pindzola & Cain (1988)
                              6Blood (1984)                                                                          17Zeine & Brandt (1988)                            28Culton & Gerwin (1998)
                              7Snidecor & Curry (1960)                                                       18Blood (1981)                                            29Anderson (2000)
                              8Weinberg & Bennett (1972)                                                   19Max, Steurs & de Bruyn (1996)              30Koike et al. (2002)
                              9Robbins, Fisher, Blom & Singer (1984)                                 20Salmon (2005)                                          31Singer et al. (1981)
                              10Trudeau & Qi (1990)                                                           21Fisher & Hong (1998)                              32Hamaker et al. (1985)
                              11Ng, Lerman & Gilbert (1998)                                              22Pauloski (1998)                                         33Mehta et al. (1995)

Table 3. Comparison of artificial larynx, esophageal and tracheoesophageal speech in terms of the therapy process and other issues.

 

Therapy Process
and other Issues
Artificial Larynx Speech Esophageal Speech TE Speech
Onset of Therapy Post Surgery Earliest of the alaryngeal options (within 2-3 days post-surgery) Later than EL, similar to TEP Later than EL, similar to ES
Duration of the Therapeutic Process to Functional Speech Shorter than ES; similar to or longer than TEP Longest of the alaryngeal options Shorter than ES, often shorter than EL
Cognitive Demands for Learning Comparable to TEP Somewhat greater than EL and TEP

Comparable to EL

Cost Less than TEP; similar to or less than EL? Less than TEP; similar to or more than EL? Most Expensive
Availability of Qualified SLP Services In urban settings and hospitals, SLPs are generally available to provide this service; services in rural areas are less commonly available (though more so than for ES and TEP) Fewer SLPs familiar with ES training these days in any setting In urban settings and larger hospitals, SLPs are generally available to provide this service; services in rural areas for TEP care are much less common
On-going maintenance of device/prosthetic Yes (infrequent) No Yes (daily cleaning; removal & reinsertion of prosthesis by patient or SLP)
Reliance on SLP post-acquisition of speech No No Yes ? particularly if using indwelling device

 

Reference List
1.      Singer and Blom, 1980
2.      Blom, Singer & Hamaker, 1986
3.      Cantu, Ryan, Tansey & Johnson, 1998
4.      Clements, Rassekh, Seikaly, Hokanson & Calhoun, 1997
5.      Hamaker, Singer, Blom & Daniels, 1985
6.      Anderson, 2000
7.      Gates, et al., 1982
8.      Hillman, Walsh, Wolf, Fisher & Hong, 1998
9.      Koike, Kobayashi, Hirose & Hara, 2002
10.     Schaefer & Johns, 1982
11.     Gress, 2004
12.     Frowen and Perry, 2001
13.     Brown, Hilgers, Irish & Balm, 2003
14.     Salmon, 2005
15.     Fujii, Sato, Yoshino, Umatani, Ito & Hashimoto, 1993
16.     Shenoy, Ashok, Premalata, Prasad, Nanjundappa & Kumar, 2000
17.     Tsai, Chang, Guo & Chu, 2003
18.     Bertino, Bellomo, Miani, Ferrero & Staffieri, 1996
19.     Debruyne, Delaere, Wouters & Uwents, 1994
20.     Eadie & Doyle, 2004
21.     Globlek, Stajner-Katusic, Musura, Horga & Liker, 2004
22.     Robbins, Fisher, Blom & Singer, 1984
23.     van As, Koopmans-van Beinum, Pols & Hilgers, 2003
24.     Williams & Watson, 1987
25.     Ainsworth & Singh, 1992
26.     Doyle, Danhauer & Reed, 1988
27.     Goldstein et al., 1984
28.     Max, DeBruyn & Steurs, 1997
29.     Miani, et al., 1998
30.     Bridges, 1991
31.     Sedory, Hamlet & Connor, 1989
32.     Trudeau, 1987
33.     Geraghty, Wenig, Smith & Portugal, 1996
34.     Kao, Mohr, Kimmel, Getch & Silverman, 1994
35.     Lentin, Williams & Sellars, 1995
36.     Mehta, Sarkar, Mehta & Bachher, 1995
37.     Singer, et al., 1981
38.     de Raucourt, et al., 1998
39.     Anderson, 2000
40.     Gates, et al., 1982
41.     del Rio Valeiras, et al., 2002
42.     Shanks, Jim, VoicePoints, http://www.webwhispers.org/news/mar2005.htm


 


       REPORTS FROM ROBOCOP?S REPOSITORY
                                                                     Or
                     News You Can Use ... by Officer Scott Bachman

                                          


MAINTAIN YOUR RECORDS


The Internet often can be like a Second Hand Store or a rumor mill.  Some things seem to go round and round and others come out of nowhere.  The following, edited for content, was recently forwarded to me by a friend.  Perhaps you will be the one who educates another regarding the need to document your documents properly, i.e. credit cards, personal identification, checking accounts, etc. 

In light of the continuing natural disasters down South and knowing full well that a man-made or natural disaster can occur anywhere, it is incumbent upon all of us to maintain our records.  It should be added to your ?survival kits? which were offered in last month?s WOTW. 

If it means anything even Robocop practices what he preaches.

1. The next time you order checks have only your initials (instead of your first name) and last name put on them. If someone obtains your checkbook they will not know how you sign your check but your bank will.

2. Do not sign the back of your credit cards. Instead indicate "PHOTO ID REQUIRED".

3 When you are writing checks to pay credit card accounts DO NOT put the complete account number on the "For" line.  Simply note the last four numbers.  Credit card companies know the rest of the number and anyone who might be handling your check as it passes through all the check processing channels won't have access to it.

4. Put your work phone number on your checks instead of your home phone number.  If you have a PO Box use that instead of your home address. If you do not have a PO Box use your work address if that is appropriate and will not create issues at your workplace. Never have your Social Security number printed on your checks.  You can add it if necessary.  If you have it noted on your checks everyone has access to it.

5. Place the contents of your wallet on a photocopy machine. Copy both sides of each license, credit card, etc.  You then have a record of what is in your wallet as well as all the account and phone numbers to call and cancel if necessary.  Keep the photocopy in a safe place.  A photocopy of your passport is also a good thing to have when traveling here or abroad.  This is critical information to limit monetary damage in the event your wallet or purse is stolen particularly if it contains credit cards and personal identification:

        
1. Cancel your credit cards immediately. The key is having the toll free numbers and your card numbers handy so you know whom to call and to keep those where you can find them.

        
2. File a police report immediately in the jurisdiction where your credit cards, etc., were stolen. This proves to credit providers you were diligent and it is a first step towards an investigation.

        
3. Perhaps the most important phone call to make: Call the three national credit reporting organizations immediately to place a fraud alert on  your name and Social Security number. This alert identifies your personal information as stolen and companies need to contact you by phone to authorize new credit.

6. Helpful telephone numbers:
        1)  Equifax: 1-800-525-6285
        2.) Experian (formerly TRW): 1-888-397-3742
        3.) Trans Union: 1-800-680-7289
        4.) Social Security Administration (Fraud Line): 1-800-269-0271


 
 Living the Lary Lifestyle          Joan G. Burnside, M.A.
  Copyright 2005

 

 
CHAPTER NINE
Tips #81 through 90

"The best way out is always through."
Robert Frost
 

TIP # 81: ALERT MEDICS WITH MEDICALERT

Wearing a MedicAlert bracelet is one link in your chain of safety precautions.  When emergency personnel spot your bracelet, they will at the very least, be aware that something is different.  When you get your bracelet, you?ll also get stickers for your door and car.

JB?s note:  MedicAlert
http://www.medicalert.org/ wants to know all of your ?conditions,? so my bracelet lists voice prosthesis, neck breather, mild htn.  It looks very cluttered and not very readable.  When I reorder I will specify that I want just neckbreather listed, so it will stand out.

TIP # 82:  BE WARY OF DAIRY PRODUCTS

Dairy products may stimulate mucus production in your mouth, esophagus and lungs, thus interfering with your voice, swallowing, prosthesis, and HME.  Try cutting back and see if it helps.

JB?s note:  I had been using a lot of half&half, whole milk, whipped cream and ice cream in an effort to maintain my weight.  I also had a lot of mucus complicating my speaking.  After I cut way back, I saw a great improvement in just two days.  It has continued. Now I drink soy milk.

TIP #  83:  REAL MEN COVER THEIR STOMAS

Covering your stoma protects you from accidents that could happen to anyone but have proven life threatening to Larys.  After all, why bother with a laryngectomy, if you won?t bother with this basic precaution?  Another reason for coverage is simple courtesy, even though the FEDEX guy has probably seen everything.

JB?s note:  I keep a ?dickey? by the front door, in case someone comes while I am in the middle of a maintenance procedure. 

TIP # 84: REDUCE THE ?UNDERWATER? SOUND

If you sound like you?re talking underwater, it?s possible that you have developed little pouches in your esophagus that are collecting mucus and causing the problem.  Try pulling your head back or turning it to the left or right.  That may compress whatever is causing the problem.  Or you may just be talking through mucus, a problem that usually diminishes over time, sooner, rather than later, for some of us. But do mention it to your SLP or doctor.

TIP # 85:  TREAT YOURSELF TO BISCOTTI

If you crave pastry but it turns to glue in your mouth, try biscotti.
This Italian invention is a very hard, crusty, sweet bread that has been baked, sliced, and baked again.  You dip it into your coffee or tea and bite off the wet part.  It is easy to swallow.  It works better than pie crust or cake, because the tongue can move the crumbs along more easily to your esophagus. You can try a single piece at a coffee shop, then buy a whole package at the grocery store if you like it.

JB?s note: Santa left a piece wrapped in cellophane in my Christmas stocking, so it was just good fortune that I discovered another way to make up for my food deprivation. Since then, I?ve also found that the cheaper biscotti is not as crumbly and turns gluey in my mouth.

TIP # 86:  UNSTICK YOUR STUCK PILL

Try chasing your pill with a swallow of yogurt or a piece of heavily buttered bread.   Of course lots of water will help dissolve it and make it swallowable.  One of the few benefits of being a Lary is that a stuck pill can?t have ?gone down the wrong tube.?  You might be able to prevent sticking pills if you swallow water first to lead the way.  If you?re in the habit of tossing your head back to swallow pills, you could be making the opening to your esophagus smaller, complicating the swallow.  So tuck your chin in.

TIP # 87:  KEEP YOUR STOMA NOISE DOWN

If you have this, it?s left over from your pre-Lary days when you exhaled to speak.  When you use an electrolarynx, exhaling has nothing to do with speaking.  Control it by exhaling more softly.  The noise is very distracting to the listener.  If you can?t make this work by yourself, ask your SLP for help in finding a remedy for the problem.

TIP # 88:  FIND THE LOST ?H?  SOUND

It won?t be the same, but it will help.  One way is to simply prolong the vowel sound that follows the H sound you would have liked to say.  Also if you take a tiny pause, just before you say the word, it prevents the last sound of the previous word from becoming the first sound of the H-word.  The last and best idea is to start to make the K sound, but don?t quite complete it.  It may sound a little like a foreign accent.  In fact, if you learned to make a French R sound in high school, you?ll have the idea.  I?ve been told that you?ll get it more easily if you speak German, too. 

JB?s note:  Remember Eliza Dolittle in My Fair Lady?  Her H problem didn?t have the same cause, but her practicing was a super example.  ?How do you do??  Make up your own list of words, then two word phrases for practice.

TIP # 89:  TAKE CARE OF YOUR CAREGIVER

We think and say that we could never repay those who have helped us so much, especially during the early days after the surgery.  But we can.  The best repayment can start with doing things for ourselves as soon as possible, even if only part of it and even if it seems to take forever.  Relieving any part of the burden is good payback. Or maybe there is some little thing that has always been your caregiver?s job. Try doing that.  Not only will you be helping your partner, you?ll be rehabilitating yourself in the process.

JB?s note:  In the waiting areas at MD Anderson, one sees many pairs of people, but some of them stand out because one person is obviously the secretary, valet, water bottle carrier, groomer and dispenser of tissues and snacks for the other.  And this is even before diagnosis and treatment! You can see how easy it is to get over your head in debt to your caregiver. (Hope you?re not the guy whose wife is still shaving him, after he?s well enough to go to a convention!)

TIP # 90:  ORDER ON-LINE AND SAVE $$$

At least one vendor gives free shipping if you order online.  If you?re calling orders in to your vendor, ask if they offer free shipping for on-line ordering.  At $12 a pop, which insurance companies and Medicare will not pay, it?s a significant saving over a year?s time.  Plus, it?s very convenient to order this way.

 

LET?S TALK:

 

Was Robert Frost right about going through?  What have you had to just go ahead and do after laryngectomy?  Are you able to help your caregiver out yet?  Or have you gotten way past that point?  Are you doing anything to compensate for the lost H sound?  Do you have your MedicAlert bracelet yet?  And how?s the mucus interference coming along?  Your notebook pages are a great place to write and draw, and to staple or paste in your WebWhispers e-mail.  Believe it or not, in the weeks and months ahead, you?ll enjoy looking back at these.


 


 
 BETWEEN FRIENDS          Donna McGary
                                     "That which does not kill us makes us stronger"
 


Look Inward

     I have a confession to make.  I know I should be grateful I am alive and relatively healthy (and I am grateful).  I know I should appreciate the Servox technology (and I do) and I should be happy that most of the people understand me very well, most of the time (and I am happy in a rueful sort of way).  But I am not content and what?s worse, I am fast getting sick of the sound of my own voice.  When it was all new and I had been without a voice for the better part of 18 months, I loved my new voice and my family and friends were thrilled with it.  We made fun of it and me and my non-stop chatter in the same relieved way people make delirious fun of a loved one who has just given them a terrible scare.

    That was two and a half years ago and the novelty has worn off.  Instead of becoming more comfortable with ?my voice?, I am becoming increasingly uncomfortable and impatient.  I loathe talking on the telephone.  I tolerate it grudgingly with family and friends and avoid it if at all possible (even when not practical) with strangers.  I am not becoming a recluse.  Far from it; since moving back to my home state of Maine I am spending more time with my family and old friends and I am still working and maintaining contacts and friendships in my old community outside of Boston.
 
     Yet I feel a palpable sense of relief when, at the end of the day, I can go back to my little condo and take that damned cord from off around my neck and stick my Servox in the battery charger.  I have found myself thinking, ?Good, now I won?t have to talk at all until tomorrow.?  There are days I wake up thinking ?I don?t have to talk to anyone today?.  Before you start wondering if I am depressed or some such other thing, you need to know, these thoughts are not troubling to me but are pleasurable.
 
   I am becoming an introvert.  Now, if you know me personally, you will undoubtedly be rolling your eyes and snorting ?As if!?  And, certainly, I am not now nor ever will be, a true introvert!  But I am becoming more introspective.  I like the sound of my own voice in my own head.  It still sounds like me with out all that distracting buzz and lack of inflection.  I can sing in my head, I can do voices and accents and tell poignant tales and funny stories. I can project my voice across a crowded room and make you sit up and listen.  I am so surprised sometimes when I do talk aloud, that all that is missing.

    It occurs to me that this is not unlike aging.  My dad and I have a favorite passage from a book by Ben Ames Williams.  Come Spring is an historical novel published in 1940 (and still celebrated in our neck of the woods) about the early settlers of Union, Maine. It follows one family?s struggles from their sea passage from England through the Indian and Revolutionary Wars.  I highly recommend it even if you never have visited Fort Western and wouldn?t know the Kennebec River from the Penobscot!  This quote is from the end of the novel - it is the conversation between our once young couple who made the journey from England separately and now are reflecting on the birth of yet another healthy grandchild.

??I think sometimes getting old is like a candle burning down.  A young one grows up and the first thing he knows he?s in love and marrying; and you can see something new in his eyes, deep and strong.  That?s like a candle when you first light it, standing up so straight and white and slim and fine; and the flame?s real pretty to look at.
     But, the candle burns on.  Maybe it melts crooked, but the flame stays just the same shape and brightness.  Maybe if the wind blows, the flame flutters some; but when the wind stops, the flame?s just the same again.  The candle keeps a-burning, and the tallow runs down the sides of it, and it gets all lumpy and out of shape like a woman after she?s had babies for twenty years or a man who likes his victuals.
     But the candle still burns bright and pretty.  The candle gets shorter and stumpier till there ain?t hardly anything left of it; but the flame?s still there, burning bright, brave and clear, right down to the very end.?

  This is what our modern culture has codified and yet somehow nullified, when we say ?you are only as old as you feel?.  But that is a lie.  You are as old as you are and no matter how young you act or dress or think or sound, you cannot cheat time anymore than I can cheat cancer.  It has taken its toll, just like time.  My face is no longer smooth and my voice is no longer sweet.  But in my mind?and on the page?I can still summon that vision of my truest self.

    That is, I think the elegance of this passage.  I am both the flame and the wax.  I am both the old voice and the new eloquence.  It is, unfortunate perhaps, that the old voice could not speak with the new eloquence, but that is the way of life.   Would that we could all be twenty-five with the wisdom of fifty.


 

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

From The Editors:
We had a wonderful article prepared from Roger telling of the beautiful sights and attractions that you would be expected to see along the Gulf Coast when IAL 2006 would be held in Biloxi, MS.  We went from being excited about the great plans for next year to mourning the tragedy the Katrina wrought.  We hoped Roger had fared better than what we were seeing on TV with the coverage of Katrina and we did receive this message from him as soon as he was able to return home and communication was available.  (By the way, IAL 2006 will now be held in Chicago, Illinois, 19-22 July.)  Welcome back, Roger!!

10/06/2005

I have been out of touch until last night due to no cable service and therefore no Internet access.  I signed up for satellite TV yesterday afternoon and of course cable service returned with in the hour..

Now for a status report: Joy and I returned home from Chattanooga on Sept 21st.  Had a lot of trees down in yard but only minor roof damage and one small broken window in master bath over tub.  Power had been restored before we returned and water was safe to drink but the destruction in this area was unbelievable.  Diamondhead is a small community of about 4500 homes and condos.  We lost an estimated 10 to 12 thousand trees, mostly large pines.  The smaller trees were more flexible and fared better.  I had no pines on my lot, but had 5 from the lot next door in my yard, all over 100 ft tall.  Fortunately, all missed my house.  I also lost 2 pin oaks and one very large live oak.   Diamondhead has a lot less shade than before Katrina! 

The beach front highway is still restricted to emergency vehicles and residents of the immediate area so I have not personally traveled on it, but have been close enough to see what happened and have seen many local TV reports (Rabbit ears to the rescue.)   The highway itself buckled in places.  All of the casinos along the Gulf were destroyed except for the Beau Rivage, the largest and newest, and it suffered extensive damage but announced yesterday that they plan a "Grand Reopening" for New Year's Eve THIS year.

The legislature passed a bill Monday allowing rebuilding the casinos on land rather than over the water as they were before Katrina and all of them plan to do so as quickly as possible.  None of the hotels suffered extensive damage above the first two floors, in fact most are being rented by FEMA for temporary housing of emergency workers.  The Isle of Capri announced yesterday that they will move the casino to the hotel building until a new facility can be built and estimate 9 months for completion.  The state also announced plans to award contracts for the two major bridges on Hwy 90 to be awarded by December with completion by summer of 2007.  But plans also call for one lane in each direction to be open by summer of 2006.  The airport is fully functional, although flights are reduced due to the loss of casino traffic.

The VA hospital in Biloxi had very minor damage, mostly downed trees in the area and has been fully operational for several weeks.  Both of the SLP's, Penny Bise and Connie Byrne, as well as the Head of ENT, Dr. Arnaud Hebert lost their homes, but all will rebuild.  (Connie's mind was taken off of her troubles by the birth of another grandson to her son and his wife living in London, so she flew to the UK to greet the new arrival.)  None of the members of the Gulf Coast Nu Voice Club were injured, although several had extensive damage to homes and apartments.

Hurricanes can be a bit more devastating than even I thought.  My previous guide had been Betsy in 65 and Camille in 69. Someone recently commented that Camille killed more people in 05 than she did in 69, and it is quite true.  I can't count the times I have heard that, "My house didn't flood in Camille, so I thought I would be OK." The benchmark killed a lot of those folks.

Highway 603 in Hancock County connects I-10 to US 90.  It is relatively high ground compared to the areas on each side, so many have had the habit of moving their vehicles from nearby homes and businesses to the shoulders of 603.  Those vehicles were ALL washed into the ditch on each side of the road.  They looked like a poorly organized salvage yard all in piles of junk.  And that road is over 7 miles from the Coast.

The trees that fell in my front and side yards were removed to the cul d' sac at the end of my street a couple of weeks ago.  Thursday, the clean up crews from Diamondhead arrived to pick  up the street side debris.  It took them 7 hours with 2 huge front end loaders and 2 large 18 wheel tractor trailers.  And the trailers were filled several times.  The pile of debris was about 15 ft high and about 40 ft in diameter.
 

 


Roger's House - After Storm

Another View

 


Houses just around the corner from mine, on the Bayou and over 25 ft above the normal high water mark had as much as 7 ft of water in them.  Unlike in New Orleans, the water drained out quickly, but the carpets, furniture, and appliances on the first floor were destroyed and wound up in curbside piles.

I have seen war zones.  Some areas of the coast were comparable.  Over  50 miles of coast line were flattened, the bridges on I-10 from New Orleans to Slidell were totally destroyed, as was the bridge from Ocean Springs to Biloxi on US 90, over 50 miles apart.  Trees were down along I-59 to north of Meridian, MS, over 100 miles from the coast.  The strength of the storm didn't surprise me.  The breadth of it surprised everyone.  It is almost 80 miles from New Orleans to Ocean Springs and the destruction along the water between them was total.

To sum it all up, the coast is rebuilding as rapidly as possible. The State has placed banners over many local roads reading "Thanks, Y'all".   I want to echo that for all of the prayers and help we have received here from all over the country and, indeed, the world.  My biggest regret is not being able to be in Boston with all of you.  But since I am now back in the 21st century with communication once again open, things will improve rapidly.

Roger Jordan, Lary class of 93


 

                          Dutch's Bits, Buts, & Bytes
 

(1) Methinks we've grown a bit!


As some may recall, we first started calling ourselves WebWhispers when we opened the "automated" email list (ListServ) in February of 1998 with about 124 participants (100 laryngectomees/caregivers and 24 medical professionals).  Our organization then officially became incorporated as the "WebWhispers Nu Voice Club" in September of 1998.

At the end of that year we had attained 216 laryngectomee and caregiver members throughout North America and abroad with an additional 50 medical & medical support personnel - for a total of about 266.  Of these, 206 (95%) participated on our Mail List.

Now, seven years later, after adding members and also losing some members through "passing on", other illnesses, invalid Email addresses, individual choices, etc., we now have grown to approximately 1,160+ laryngectomee-caregiver members and about 227 medical/medical support and vendor members worldwide - for a total now nearing 1,400!!  Of these, about 1,110 (80%) participate on our Mail List.

My personal thanks go out to all the officers, contributing members, and general members who have made this growth possible as we continue our outreach to the laryngectomee community.  God bless you all!

(2) What is your "FICO"?  Should you care?


First, YES, you should care!  This is especially true if your "larynx cancer experience" has significantly altered your income, savings, investments, etc., and/or caused you financial hardships.

Your "FICO" is your three-digit credit score, between 300 and 850, and named after the company that created it, Fair Isaac Corporation.  Lenders use this score to determine what interest rates you pay.  The lower the score, the MORE you pay.  Scores above 700 get the best rates.  Lenders also use this score to decide whether to approve your credit application, whether to increase your credit limit, and how to treat you if you make a very late payment.  Your FICO score is not determined by your age or income, but rather by your past use of credit, as recorded by agencies like Experian, TransUnion, and Equifax.  Some say up to 80% of agency credit reports contain errors.  To make sure YOUR credit report is accurate, you can now order a FREE annual copy from each agency

To illustrate the importance of your "FICO", an October 2005 survey by "Parade Magazine" revealed a snapshot of what borrowers with varying credit scores nationwide were charged, on average, on a $200,000, 30 year, fixed-rate mortgage.  The difference in cost between the highest FICO score and the lowest FICO score eligible for this loan was a whopping $478.00 a month, or $5,756.00 a year - which added up to $172,221.00 over the life of the loan!!   See below examples:

FICO Score        APR          Monthly Payment      Total Interest Paid Over 30 Years
 720-750            5.793%             $1173                      $222,141
 700-719            5.918%             $1189                      $227,888
 675-699            6.456%             $1258                      $253,008
 620-674            7.606%             $1413                      $308,671
 560-619            8.531%             $1542                      $355,200
 500-559            9.289%             $1651                      $394,362

 

(3) QUESTION:  I have heard that some printers embed a secret coded dot pattern on each printed page, and that if you decode the dots, you can determine the owner of the printer and the exact time the page was printed. That sounds like a privacy violation -- is it true?"

ANSWER:  Yes, it's true.  In an effort to snare counterfeiters, the US government has persuaded some color laser printer manufacturers to encode each page with identifying information.  The EFF (Electronic Frontier Foundation) has recently proven what many have suspected for a long time - that at least some laser printers embed a secret machine identification code on every page they print, which reveals when the page was printed, and the serial number of the printer on which it was printed.  You might not think it's a big deal that your printer's serial number is embedded on every page.  But if you registered your printer with the manufacturer when you bought it, the manufacturer knows that you are associated with that printer's serial number.  Bottom Line: Law-abiding folks have nothing to fear -- and let's get those counterfeiters!!  :-) .

 

 

   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) ...

DUELISTS

In a perpetual personal feud, Duelists generally don't menace anyone but each other, unless,
of course, another Warrior foolishly gets between them.  They may not even remember what
started the fight, but not that they cordially loathe one another and seize every chance to go
at each other.  When the other Warriors eventually weary of their endless kvetching the
Duelists will be shouted down or the Moderator
will ban them.  Even after getting the heave-ho
from one forum, however, it is not unusual for them to seek each other out in other forums to
renew their "fencing."

Above courtesy of Mike Reed
See more of his work at: http://redwing.hutman.net/%7Emreed/  
 

 

   Welcome To Our New Members:

 

I would like to welcome all new laryngectomees, caregivers and professionals to WebWhispers! There is much information to be gained from the site and from suggestions submitted by our members on the Email lists.  If you have any questions or constructive criticism please contact Pat or Dutch at Editor@WebWhispers.org.

Take care and stay well!
Murray Allan, WW President

 

     We welcome the 33 new members who joined us during October 2005:

 

Anthony Balicki
Briarcliff Manor, NY
Deborah Berwick
Hackberry, LA
David Bishop
Brighton, MI
Donald Blair
Westland, MI
Jack Briner - Caregiver
Summerville, SC
Nora Criswell - Caregiver
Loganville, GA
Mary Decoite - Caregiver
Discovery Bay, CA
Eric Dolinger - SLP
Newark, DE
Richard Fero
Niceville, FL
Girgoriy Dubov
Omaha, NE
Karen Griffin - Vendor
Temecula, CA
Debra Hansen - Caregiver
Fort Myers, FL
Steven Hasty
Lynn Haven, FL
Rosemary Hauck
Newberry, FL
Diane Jordan - Caregiver
Virginia Beach, VA
Juanita Larracey
Machias, ME
Jerry Marler, Sr.
Bossier City, LA
Steven Mills
Perry, FL
Al Novak
Brainerd, MN
Larry Nuehring
Newton, KS
Lorrie Pearo
Blossvale, NY
Mandy Pietropaolo - SLP
Collegeville, PA
James Rushton
Lancaster, PA
Ananth Shenoy - Larynx Cancer Patient
Noida, U.P., India
Viola May Sells
North East, MD
Robert J. Smiley
Port St. John, FL
Lawrence Smith
Lakewood, CO
Vanessa Smith
Essex, UK
Jamie Stephens
College Station, TX
Dr. Dana Thomas - SLP
Desoto, TX
Tina Wilkie - SLP
 Newcastle, NSW, Australia   
Diane E. Williams
  Melbourne, Vic., Australia
John Wozniak
Punta Gorda, FL


 


 
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............VP - Web Information
  Terry Duga.........VP - Finance and Admin.
  Libby Fitzgerald.....VP - Member Services
  Dutch Helms............VP - Internet Services
      

  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   

 

 

Disclaimers:
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.
************
The statements, comments, and/or opinions expressed in the articles
in Whispers on the Web are those of the authors only and
are not to be construed as those of the WebWhispers management,
its general membership, or this newsletter's editorial staff.



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.



  ? 2005 WebWhispers
Reprinting/Copying Instructions
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