This month we are pleased to debut a new column….called My Neck of the Woods…it’s a chance for you to tell your story in your own words .You don’t have to be a writer…you just have to be able to type it out and hit ‘send’! It can be an anecdote or an update…something that isn’t perhaps just right for the day to day list, but you would like to share with us all. We have pieces on caregiving and acceptance lined up for future months. I met our first contributor, Dennis Holte, at the Chicago IAL. Annual Meeting. He and his wife, Mitzi, were just such an attractive and engaging couple and I was particularly impressed with Dennis’ voice. He graciously agreed to send me something for the newsletter. I think his article on the journey from The Lump to a Lary is a fine inaugural piece for this column. Thanks, Dennis!

A Brave New World

Dennis Holte ~ Boise, Idaho

My journey into the world of larys began at age 52, in March of 2004. I had spent the previous 3 months on and off antibiotics for what I was told was bronchitis and maybe pneumonia. One day I noticed a lump on my neck about the size of a marble. It didn't hurt, but was hard as a rock. I went to my regular doctor and with a look of "this is not good", he sent me to an ENT to see The Lump. On April 1st, the ENT stuck a needle in the swollen lymph node. He returned 5 minutes later and told my wife and me that it was malignant and was probably stage 3 squamous cell carcinoma.

We looked at each other and said, “It is April Fool's Day, maybe this is a joke”. We were in shock and knew life would never be the same.

He told us this type of cancer was very aggressive and deadly. He also said that it was very curable, but one of the most painful and destructive to treat. We asked him what our options were for treatment. He said they have had good results with a combination of chemo and radiation. The other choice was a laryngectomy

We asked if there were any other alternative treatments available and he acted like we were asking for the name of the nearest witch doctor and said, “No”.

After they did the biopsies from my throat, he called it an unknown primary and kept saying it maybe was at the base of my tongue, although the malignant biopsy was from my larynx. We asked for my records and got the opinion of two other medical centers.

After learning what we could, I decided to take the gamble of what I was told was an 80% cure rate with chemo and radiation.

In May of 2004, I started 37 IMRT radiation treatments and 3 doses of chemo at Mountain States Tumor Institute here in Boise.

After finishing treatment and having a CAT scan in August, we were told I was cured and we just needed to watch to see if it returned.

Well as you all know, and all too well, that was not the end of my journey. It had just begun.

Over the next few months, I would go to the ENT and Radiologist for follow ups and to complain about the pain I was still having. They would say it should get better; that we needed to give it time for the radiation effects to settle down. By now they had switched me to morphine for what I called the ear ache from hell. When we would go in to see the ENT, he acted like he was too busy to listen to our concerns. In November, I fired that ENT and switched to a different one in the same building.

The new doctor did the scope down the nose trick and another CAT scan. They both showed nothing. Then he put me under and took 10 biopsies from my throat. They all came back negative for cancer. We all said that's great news, BUT, I still have this ear ache from hell and am living with morphine. Something isn't right!

Finally, they sent me in for a PET scan and that showed a large tumor on my voice box. I was told my only chance of surviving was to have a laryngectomy.

So, on August 12th, 2005 I joined the world of larys.

In October they had to take a flap from my chest to close up the large fistula that had refused to heal.

In November, I had 20 hyperbaric oxygen treatments, a TEP installed and the feeding tube removed. So far so good.

While searching the internet after surgery, I stumbled across WebWhispers. This last year of recovery would have been next to impossible without all the support and information I have received here. God bless Dutch and all of you that help make this website a great support system.

Can One Person Make a Difference?

by Jewell Hoffman

Do you remember when you met your first Laryngectomee after your surgery? Do you remember how you felt? Were you still in the hospital when you met? How were you feeling? How did your spouse or caretaker react? What were your thoughts after they left? What were your thoughts before they came into your life? How differently would you have felt if you had not met them for a very long time? Just how significant was that person and their visit to you?

Six days after my surgery, as I was contemplating my life, my possibilities, my new direction in life, a man burst into my hospital room, flung his arms wide open and said, "Welcome to my world". He was a well dressed man in a suit and tie. He was well groomed, and flashed a beautiful smile. As he walked towards me, I noticed he was chewing gum!! At the time, I couldn't even swallow and didn't know if I ever would again!! I looked up at him and mouthed............."You're chewing gum!!" He said, "Sure I am!" By then I had collected myself a bit and mouthed again........."You can talk!" He looked at me with a confident smile and said "Yes, of course, and you'll be able to talk again too!" He was using what I later learned was Esophageal Speech. Back when I had my surgery, the TEP was just being researched and perfected. The most prevalent forms of speech being used were Esophageal Speech and the Electrolarynx. I couldn't believe how great he sounded!! I was so excited! And because my throat had been so painful, I didn't realize that I'd ever be able to eat again. His name was Gene Yoes, and I will forever be in his debt. Since then he has passed away, but I will always remember how he took time out of his life, to come and visit me in the hospital, to let me know that everything was going to be okay!

My life was changed after that meeting. My whole demeanor was pumped up and ready to face life's new challenges! I quickly became involved in my local New Voice Club. I became the Secretary. The President and I Co-Chaired an International Association of Laryngectomees (IAL) Convention here in New Orleans. I was practicing my Esophageal Speech all the time. I attended my first IAL Voice Institute and Convention, which was one of the most wonderful experiences of my life. It was there that I finally began to use my new voice out in public. It was the first time since my surgery, that I was in the majority rather than the minority. I met "women" laryngectomees, which back then were much fewer than they are today.

As time moved on, I became President of my local club, ran another IAL Convention in New Orleans, was on the IAL Board of Directors, became involved with my local American Cancer Society and sat on its board, was a frequent visitor to "new" Laryngectomees in the hospital. As I had my children, I became more involved in my local community, and on the children's School Boards and PTA's. As time went by, my Speech became more and more proficient as I continued to practice and try new things. I became the Secretary and President of three school PTA's (elementary, middle school and high school), became the "Mom to go to for fund raising", ran two school Spring Fairs, was interviewed for t.v. and newspapers, later became a part of Toastmasters and then the National Speakers Assn., as I traveled and spoke to many different organizations.

As I reach my 48th year on this earth, I find myself continuing to evolve. Over the last 26 years since my surgery, I feel that I've accomplished a lot, but I'm not quite finished yet. I still have a lot of dreams in my heart to pursue. Now that my children are grown and most are on their own, I look forward to concentrating on my strengths and continuing to grow and learn new things. I have been blessed in many ways. I am ready to begin this new era of my life, and hope that the things I've learned along the way, will help me to continue to make a difference in the lives of others.

I sometimes wonder, had that wonderful man not popped into my room with his arms widespread, welcoming me into his world, would my life have been the same? I always hope, that I have made the same difference in the lives of others that I have visited, and helped to teach to speak again. I think that most Laryngectomees that have been fortunate enough to have been visited, become the visitor in their local area too, or find some way to contribute to their local group. It is in giving that we receive. If you ever wondered if there was something that you could do in your life that could REALLY MAKE A DIFFERENCE...............THERE IS. When you have healed and are ready to get back into the business of life again, take time out to visit a new fellow Laryngectomee. Call your local Speech Therapist, ENT, or his nurse, get their approval, and prepare to feel the joy of your life by visiting newly Laryngectomy patients and their families!! One person CAN make a difference. Look at the difference Gene Yoes made in mine. The truth is........I need not wonder.......I KNOW he made all the difference in the world to me and my new life. I hope that you too will feel the wonder of bringing someone's heart back to life again, and giving them back hope for a wonderful, productive future.
God Bless!

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

In My Own Words: An Altered Life

By Libby Fitzgerald

Conclusion of a two part series

[note from the editor: Last month, Libby shared with us excerpts from the journals (actually, one-sided responses written during “the silent times”) she kept in her early days of diagnosis and treatments leading up to and including her laryngectomy. We join her this month as she prepares to go home from the hospital after surgery…noting where we pick up the journals, we can see Libby never lost her characteristic good humor!]

[Then, a post surgery milestone:]

 "Had 1st B.M. today. What a build up!"

[Describing doctors' rounds at this teaching hospital (Mt. Sinai):]

"You should have seen the group of residents that came in this A.M. About a dozen and Dr. U. Talk about an invasion!"

[A personal observation of my husband:]

"Please do yourself a favor and get new reading glasses soon. They're green, scratched. Thick headed! Testa Dura!"

[These last 2 words are Italian for thick headed, an expression often used by my mother. Made us both laugh.]

[Complaint Department: Does any of this have a familiar ring?]

"I spend most of the time stuck in chair, hooked up to meals on wheels."

"My veins kept rolling and they had to keep jabbing."

"Wish I could blow my nose. Tube is stitched into nose."

"I start coughing, gagging then some vomiting for no reason."

"Please hold off feeding until later. I had lunch for over 2 hours, which finished around 4:00."

"Can you give me anything for the nausea?"

"I'm uncomfortable. Have diarrhea."

"Could I have a clean gown? Got water on this from the nebulizer."

 [Back to the discharge date concern:]

"I've been having some problems with gagging since Wed. P.M. Slowed flow of food. Still acts up."

"Realistically, Friday too early. Try for Saturday, but let situation decide.

"Must tell husband to let friends know no more mail or flowers to hospital."

"I'm supposed to go home tomorrow so I need to know what to do."

[Finally, the night before discharge and the last minute flurry of things to do]

"Could you give a tube rinse by syringe? The stuff in the feed bag looks congealed. Please, let's get this over with! [2-1/2 hours]. I want time to sponge bathe before my husband comes."

[To nurse]

"Could you call my husband before he leaves home, to let me know what supplies we have? [delivered by medical supply] I will take things from here that I need."

[Husband later walks in with lots of supplies:]

"That was some bunch of "loot" you brought me! Thank everyone when you talk to them."

[Last minute check:]

"This is regular Jevity not Jevity Plus. That type gave me diarrhea. Glad I thought of it now rather than later. Call Jill to be sure food cans are Jevity and not Jevity Plus. I don't want a bunch of that!

[General chitchat with husband:]

"When I'm home, I'll have to watch you eat real food. Oh well, maybe I'll shed some extra pounds."

 [Side effect of surgery - did lose weight and kept most of it off:]

"Yesterday was the first time I wore underwear and something other than a hospital gown."

"You can order Chinese some night for a change - at home, I mean."

"I must be getting better. I'm starting to really visualize food."

"Wish you could have met my regular night nurse. This is her day off. You would enjoy talking to her. We had a nice "visit" last night."

"We can ask the friends who volunteered to do food shopping."

"It's such a relief not to look at that damn clock."

[Finally, in the car and on the way HOME!]

"I can spit into tissues."

"Silly me. I forgot that I have a portable suction machine which can be used in the car. You can hook it up to the cigarette lighter."

[And getting back to normal topics:]

"Are the leaves turning?"

"See any deer?"

Notebook # 3

[Sept. 25, 1998…To husband while getting ready to go to bed]

“MY OWN BED!”

 [Because the doctor didn't want me swallowing saliva yet, I had to figure out ways around that.]

"I'm going to use the toilet paper method tonight.' [Spitting into toilet paper and tossing it into a bag. Cheaper than Kleenex.] "I would have to turn the suction machine on every time I wanted to use it and that would wake both of us up. The nebulizer will be noisy enough."

[Next morning to husband:]

"I have a big favor to ask. I want to sit in the shower on 1 of those white plastic chairs to take a shower/bath. Would you scrub my back? Also, I need to wash my hair, but I'll need you to help me. If you saturate washcloths with warm water, then soapy water, then a careful rinse, that should do it." [The hair washing was done over a sink. The shower with a removable shower head.]

"Don't be shocked, but I'm a scary, bruised mess."

[Visiting nurse arrives and finds me sitting with the blow dryer:]

"Good morning! I'm trying to dry my hair."

[Question and answer period:]

"Yesterday I only had 4 cans."

"Do I dissolve all my morning meds at once?"

"Do I need to use a new feed bag or can I use the one from yesterday?"

"It takes long to feed."

"I'm meeting with someone from a laryngectomy support group at 3 today. They will lend me a voice prosthesis."

[At this point, I was unfamiliar with the term laryngectomee, just the name of the surgery. Also, I mislabeled the EL as a prosthesis. Had a lot to learn!]

"Here I've never been a smoker. Go figure."

[Gave nurse my medical history.]

"Until this all happened, the only time I was in the hospital was to have my kids."

[Chitchat with Visiting Nurse, asking about our house and property:]

"Things aren't usually this cluttered, but things have been piling up while I was away."

"2 acres."

"My husband built the deck this summer. He's a biology teacher. He's always loved carpentry. Helped him cope with all my stuff."

"He doesn't want me to be alone. We have friends who will come and visit and give him a chance to get out."

"Would you mind if I lie down on the couch? You could read or catch up on your paperwork."

[Getting up, bathed and dressed really tired me out!]

[Had many discussions about the time my husband was taking off from work. As a very conscientious teacher, he had just started the school year with his new students and was then out of school for my surgery. He didn't want to leave me alone at home, but also didn't want to be away from his classes. We were trying to figure out how to resolve this.]

"Perhaps, if it's OK, Karna can come tomorrow. Maybe we can ask her to spend Tuesday here and you can go to work and then prepare for Thursday. Then we can have Tim and Lisa up for Friday."

"I'd like to minimize the days you take off from school, because I know it ultimately creates more backlog for you. If it's necessary, of course, but with these offers to help, why not take advantage?"

"I don't put that shirt in the dryer. I hang it."

[Next visit from Visiting Nurse:]

"Thank you for coming."

"All right."

"Reasonably."

"I don't swallow, but it's not bad."

"The surgery was more extensive than originally planned and they will wait until healing occurs."

"We use humor all the time."

"My meals on wheels."

"Some friends will be visiting this week and he can go to work."

"They sent me home early because of my familiarity with trach care and felt I could handle feeding."

"If you need to leave before he returns, that's OK. I feel well."

"When I see real food I salivate."

"I consume 6 cans/day + water. Jevity + many vitamins."

"I really didn't know what to expect, but I try to roll with the punches."

"When I first looked in the mirror at the hospital, I was shocked. I looked pale as a corpse & my neck looks like a linebacker, so I put the mirror away and slept."

"My husband has made much possible."

"We're going to speech pathologist at Mt. Sinai on Thursday."

[Doorbell rings and coordinator of local club comes in bringing flowers.]

"Thank you! Those are lovely!"

[When asked about getting my own Servox, referring to my SLP:]

"She is ordering one. I will return it"

[Speaking about the EL borrowed from the local club.]

"How often does the battery need recharging?"

" I tire easily."

"Thank you so much."

[The usual ups and down of recuperation:]

"I got up around 5 with a headache & took Tylenol. It took a while before I went to sleep. My back feels a little stiff thru the shoulders. Must be getting old."

"I'll leave a note for her. Tell her to let herself in. I may still be asleep. She can fix a pot of coffee & bring things to read or whatever."

[The friend I was referring to not only came with reading material, but volunteered to weed my overgrown flower garden. Now THAT'S a friend!]

"I have lots of healthy weeds. You'll be in ecstasy!"

"The quality of my charades seems to be improving. I'm getting more across "saying" less."

[To my husband:]

"I'm going to Teresa's wedding on Oct. 16th."

[Less than a month after surgery]

 "Don't know how long we'll stay, but will see."

[To some visitor:]

"My healing looked good from the outside. Maybe it's also good on the inside."

"My stubborn determination."

"Don't know if John explained, but I'm not allowed to swallow anything, so I have to spit every time my mouth fills with saliva. I can't wait to stop this."

[In between all this, I'm discussing real estate business by note. The "show" must go on]

"I need a favor. You'll have to give directions to the house from New Milford for a florist. I'll write them down for you."

"Writers cramp."

[Then some old friends arrive:]

"These are my friends, Bob and Karna." Known them over 30 years."

[Referring to feeding tube:]

"Hopefully, I won't need it much longer."

 [Chatting with friends:]

"I shower from the chest down and use washcloth for upper. John washed it for me at the sink."

"Pretty soon, I'll take my first nap."

"I haven't felt like reading yet - just short stuff, but pretty soon. I've got some great mysteries in the family room. Sue Grafton. Kay Scarpetta."

"Nap outside on lounge?"

"I really miss tasting food."

"I'll be doing my trach care in the bathroom."

"Like my stylish bib? Meant for this purpose to cover trach area."

"I could wear a scarf, but this is meant to allow air circulation too."

"These were crocheted for this purpose & given to me by the cancer support group. I have a bag full."

"Last night, John barbequed sausages & they looked so good I put a piece on my tongue & savored it. Later, I had a "taste" of cake."

"I'm going upstairs for a nap and am turning on my vaporizer, so you'll hear that noise. See you in a little while."

[Husband gets home from work and we discussed the day:]

"I tried to behave today."

"They brought a cooler with their own lunches. I "scolded" them."

"Tomorrow, we'll put a shopping list together. I'll help with the list part, but you're stuck with the shopping part. Oh well. Not for long."

"The visiting nurse came this A.M., took my vitals and visited a bit. I don't expect much assistance, but I don't think I need it."

"I'm going to go suction."

"I'm sucking on a Tic Tac and it tastes good!"

"I must say, the med. supply company has been very accommodating."

"The nurse said that ginger ale works thru clogs. Must be the bubbles."

[Fixed a very simple dinner, but that tired me out]

"Just taking a breather."

[Still, it felt good to be doing a normal routine!]

[Getting ready to drive in for first post-op doctor visit:]

"When we get to hosp. want you to drop me off before parking & I can sit & wait for you. Must be a chair somewhere for me."

"Will take calcium before we leave. Feel tingle in face, arms, legs - from exertion of coughing and trach care."

[After coughing calmed down on drive to city:]

"Maybe I'll just go with you to parking garage. I think I feel more confident & walking is OK."

[Wearing an "artful" scarf around my head covered the feeding tube effectively enough so I didn't draw any stares. Of course, in NY City, artful head coverings are standard and no one would notice. LOL!]

[This visit got the doctor's OK to remove the feeding tube that was stitched into my nose to keep it in place. Snip went the stiches and out came that unlamented tube.The swallow test took place next; I had to try to drink a cup of water. Not as easy as it sounds after more than 2 weeks without swallowing. I sipped cautiously and got the most awful taste in my mouth, but I had to make it work, so I kept sipping a few drops at a time until I got it all down. Yahoo!! I can officially eat again! Also met with the SLP to learn speaking techniques with that borrowed Servox]

[When we got home that night, there were several family members visiting. It was so good to see them all: our son, a brother-in-law and his wife and a nephew and his wife. While they all sat down to dinner, I opened a can of Progresso Chickarina soup. I put it in the blender, heated it up and then tasted the most heavenly food to my starved taste buds. Ahhh, how good it felt going down, savoring all those flavors like a connoisseur of fine wines. I will never forget that first meal and still think fondly of that delightful soup.]

[I started practicing with the Servox and attempted my first verbal conversations. I had to repeat myself and use body English at times, but generally got my ideas across. After a while, my voice got lower and lower, like an old record at slow speed.]

"The battery faded on my voice box so I'm truly voiceless while it charges. I should have charged the spare battery, but didn't expect this."

[First complication after coming home:]

"If Colleen from the Visiting Nurse Assoc. calls, tell her I would like to see her one last time. I have some questions and want her to look at the area around the trach opening."

[Still not using the term stoma.]

[Nurse arrives:]

"I've been putting some Bacitracin on my neck, but it still looks red and feels raw. Should I do anything with the skin graft area? Do you have any advice you think I need?"

"Should I use Vitamin E on it?"

 "Do my lungs sound clear?"

[I sure am full of questions!]

 "I clean with kits 3 X day & use saline squirts. Once a day I remove entire tube & clean. At night I use the nebulizer."

"We have to get a whole house humidifier. Do you have any suggestions? What type? Where to buy?"

[Too bad I didn't know about WW yet. These questions could have been answered by people with experience. The visiting nurse wasn't able to give definitive answers.]

"My brother-in-law and sister-in-law have been here since Thurs. & are leaving tomorrow. I will then be "flying solo."

"We already notified 911."

"I go for a checkup on Oct. 22. Then we'll see when I get the implant. They couldn't do it before because they had to remove more than expected."

"I would not be a candidate for a transplant. I would have to take immuno-suppressants and not advisable for me."

[So here we are, exactly 8 years later. There have been many ups and downs over the years, but mostly ups. It's been quite a journey and if I forget that, I have these notebooks to remind me.]

    Practically Speaking ...
                                                                                 By Elizabeth Finchem, Tucson, AZ
 

Esophageal Speech

by Elizabeth Finchem

Practically Speaking about my personal experience with esophageal speech, it begins with my pre-op counseling at Mayo Clinic, in Rochester, MN. Sitting in Bob Keith's office I was given the opportunity to view the H.E.L.P. videotape featuring Barbara Nitschneider and Anne Lanpher, both were teaching their classes speaking esophageally. I think that is when I concluded that it would be possible to have a laryngectomy and speak with a feminine voice that would be close to normal.

The decision was made and the pre-op tests were ready for Monday morning surgery. I flew home for the weekend to prepare my family for what was about to happen. I had a copy of "Looking Forward" to help with drawings and written explanation I could read aloud and discuss their concerns. My six year old daughter broke out with Chicken Pox Saturday night, and Sunday morning my second son, who was attending college in another State, was put in the infirmary with encephalitis from a severe sinus infection. What to do? You leave all in the best hands available, say your prayers and get on the plane back to Mayo Clinic to keep your surgical appointment.

A few days after my total laryngectomy, I was wheeled down to Bob Keith's office to begin speech therapy. He dutifully introduced me to the electro larynx. I promptly told him that "I wouldn't need one of those because I planned to go home with at least a working vocabulary using esophageal speech." It didn't happen.

It was about a week later when I saw my local SLP and she tried again to help me with the EL. I grudgingly took it home to "play" with it, and see if it would help me communicate with my family. I was awful. The swelling, the radiation burn, and the offensive clatter it made seemed useless at first. Slowly I mastered it well enough to even use the telephone successfully. In my mind, this was only temporary!

My family & friends continued to get me to radiation and speech therapy regularly in spite of blizzards and icy roads. Over the next few appointments I managed to get plenty of air into my esophagus but it took much longer to hear my first esophageal sound. It happened one evening. I was relaxed following a bath and sitting in my robe and nightgown, watching TV with my family and enjoying some pop corn and a beer. I turned my head slightly to the left and said, "What"? It was a beautiful feminine voice similar to those I'd heard on the videotape. I cried as I realized that one day I would reach my goal. It was a real possibility after all.

It took me a long time to fully understand the dynamics of what happened in that magical moment. The emphasis during speech therapy with several different instructors was to read long lists of words that would put air into my esophagus. Now I understand, but I didn't then, that they expected me to eventually get full enough of air that some of it would go North and come out as esophageal sound, instead of going South to fill my suffering gut with more air. I remember being told, "when you feel the pressure rising, use the 'burp' to say something...anything. Like, "rubber baby buggy bumpers". Huh? Problem was I didn't know how to burp. I refused to allow a repulsive burping sound out, and I had no intention to learn that so called "skill".

But now, I had heard my voice. I didn't have to burp. I could somehow produce a sound that was similar to my pre-op voice. My search, for how to make that happen all the time, began. Some said it was the beer, some said it was the sipping. They both probably contributed, but the secret was the "wh" that opened soft palette.

In spite of the fairly common physical set backs such as burn, fistulas, and hypothyroidism (due to the laryngectomy surgery and radiation), I continued speech therapy. Mayo Clinic's Laryngectomee Rehab Seminars and the IAL's Voice Institute were essential training for the basic information I needed to figure out what worked for me. My determination to accomplish esophageal speech played a part in my declining Eric Blom's offer to try the TEP in June 1979. I explained to him that I was working on my ES, and I also planned to learn to use the Larkel so I could continue swimming. The TEP is still available if I need it one day.

Mastering the three methods of air intake for esophageal speech is essential. The other half of that procedure is learning how to release the air for sound. In addition to the Voice Institute that meets every year prior to the IAL Annual Meeting, there a number of books available. There are explanations and word lists to use for practice. I prefer not to use word list when I teach because I know it is more useful to know how to allow the air that is under pressure in the esophagus to come up and out immediately. The key for me was the "wh" in what. It opens the soft palette and helps the sphincter at the top of the esophagus to open enough for the air to rise up & out as whatever sound we shape with our mouths. The interrogatives work well: who, what, when, where, why, and I add white, whale, while, etc. for good practice. If esophageal speech is going to be a useful, no hands needed, backup, than a single word will work to begin with.

I encourage each of you to learn all you can about the mechanics of alaryngeal speech in general. There are so many misconceptions about EL, TEP and especially ES...

For example: "SUPERCALIFRAGILISTICEXPIALIDIOUS'' IN ONE BREATH is using one breath of lung air. However, esophageally, it is broken down into syllables, and air is fed into the top of the esophagus with every consonant. That air is immediately used for every vowel that follows. If you are singing the vowels are held longer and the air is used more efficiently before the next consonant injection of air.

A more helpful way to measure the number of vowels per injection of air into the esophagus is "strings of vowels". On one injection of air begin with "aeiou, aeiou, aeiou" and see how many sets you can say before you lose sound. Don't stop between each vowel and keep your voice very soft. Volume will use up the available air, when the goal is the number of sets you can utter on one injection of air. This is an excellent exercise, especially if you need to say, "supercalifragilisticexpialidious" , you will have practiced like a marathon runner.