September 2004


 

 

Name Of Column Author Title Article Type
Musings From The President Murray Allan How To Change A Prosthesis News & Events
VoicePoints Katie Dietrich-Burns M.S. Pre-Treatment Consultation For Larys Education-Med
WebWhispers Columnist Terry Duga Keeping A Seal Experiences
Roger's Ramblings Roger Jordan Biloxi In 2006 Experiences
Campfire Philosophy Paul Galioni Academic Creep Experiences
Bits, Buts, & Bytes Dutch Computer Tips Experiences
Welcome New Members Listing Welcome News & Events

 

 

                Murray's Mumbles ... Musings from the President

               
How to change a prosthesis - Very carefully
 
I was driving along on a hot day last July and grabbed a bottle of  water and took a big swig.  I started coughing immediately so I though that perhaps my prosthesis flap was stuck open OR I had a "leaker".  When I arrived home I drank some more water and sure enough it leaked again.  No problem - I have changed these valves dozens of times without a hint of a problem.  I assembled my 22 Fr stent, gel cap and loader  with some lubricant and a brand new prosthesis.  After having the stent in place for 2-3 minutes I removed it and inserted the new valve into my tract.  This is when the trouble began.  For some reason I did not have the right angle so I tried again.  Success, or so I thought, the valve was in place, NOT.  There was mucus on the insertion stick when I slipped it off and to my horror the prosthesis was not to be seen.  I thought it had dropped on the bathroom counter or floor and wasted precious time looking around for it.  Five minutes or so later I started to cough violently.  For sure, I had aspirated it and it was in my lungs.  Instead of immediately dropping to my knees and coughing aggressively I had wasted precious time searching the bathroom for it while it dropped further into my lungs.
 
My good wife heard me coughing madly and came upstairs to check.  I manage to say, "call 911".  Fortunately, I had visited my local firehall and EMS and explained my condition as Dutch Helms, our faithful Webmaster, had suggested some time ago.
 
Within four minutes a huge firetruck was at my door followed shortly by TWO Advanced Life Support ambulances.  June explained the problem and I was whisked away to Richmond General our local hospital.  Luckily, there was a lung specialist passing through the ER.  He had an x-ray taken and visualized the prosthesis in the right bronchial tree.  He inserted a lighted bronchoscope into my trachea but after several tries was unable to retrieve it as the claws would not open wide enough.
 
Another ambulance ride to Vancouver General Hospital ER.  I saw another lung specialist but they were busy at that time so I was admitted and remained over night.  At noon the next day I was "scoped" again and this time the offending valve was removed in a minute.
 
Lesson learned - If you lose your prosthesis during insertion always assume that it has been aspirated.  Drop to your knees immediately and cough vigorously - time is of the essence - as it will be going further down into the lungs as you breathe.  While in the hospital I was given copious quantities of intravenous antibiotics to prevent infection.  However, when I spoke with my ENT a few days later he said that it could have remained in the lung for days and not be a problem.  I'd prefer that it didn't. Anyway, I now have an x-ray and a neat color photo of the valve in my lung.  NEVER AGAIN!
 
Best regards,
 
Take care and stay well, AND be careful when doing a change!!
 
Murray


 VoicePoints [ ? 2004 Dan H. Kelly, Ph.D. ]
  
  coordinated by   Dr. Dan Kelly, Retired Associate Professor ( dy_kelly@msn.com )
                                Department of Otolaryngology, Head & Neck Surgery
                                7700 University Court, Suite 3900, West Chester, OH  45069

? September, 2004 Katie Dietrich- Burns, M.S. 

Essential Elements of Pre-Treatment Consultation for Laryngectomy Patients

Katie Dietrich-Burns M.S. CCC-SLP
Senior Speech Pathologist, Clinical Head & Neck Specialist
The Milton J. Dance, Jr. Head & Neck Rehabilitation Center
The Greater Baltimore
Medical Center

     The speech-language pathologist may be introduced to laryngectomees at any stage of the care continuum, from initial diagnosis to post-operative rehabilitation. The timing of service provision varies greatly due to the specific circumstances involved in individual care. Although initial patient encounters may vary greatly, there are some general guidelines for a successful ?pre-treatment? intervention.

     Frequently, patients may feel that there is no need to meet with the team prior to surgery, because the physician has explained the procedure already. It has been estimated that less than one-half of all laryngectomees are referred for pre-operative rehabilitation counseling (Salmon, 1994). It is important that prior to hospitalization, patients have a chance to meet the rehabilitation team, to ask questions, and to express concerns that they may not have been able to make during their meeting with the surgeon.  Patients who have pre-operative counseling are generally more compliant and less anxious during treatment (Groher & Gonzalez, 1992).

     Ideally, the speech pathologist or rehabilitation team would meet with the patient after his diagnosis has been determined and the treatment options have been presented. Information about the impact of various treatment options on communication and swallowing may assist the patient in his or her decision making process if total laryngectomy, near-total laryngectomy, supracricoid laryngectomy, or laryngeal preservation (chemotherapy and radiation) procedures are being considered.

     Patients at the Milton J. Dance, Jr. Head & Neck Rehabilitation Center undergo pre-treatment consultation several days prior to surgery. Patients are encouraged to invite family members or close friends to this meeting. Members of the rehabilitation team, including the head and neck nurse specialist, oncology social worker and speech pathologist, review the patient?s medical records and surgeon?s notes. From these notes, the team identifies if additional procedures, such as neck dissection or tracheoesophageal puncture are planned.

     At the pre-operative consultation, the nurse specialist records the patient?s baseline vital statistics and confirms that the patient has completed all pre-operative testing.  She reviews the details of the operation and discusses how to care for the patient while in the hospital. The social worker assists the patient by discussing avenues of financial assistance and resources that provide psychosocial support. The speech-pathologist discusses acute post-operative feeding, swallowing and communication.    

     A good starting point is to introduce yourself and the other team members and to outline each member?s role on the team. It is beneficial for the patient to tell his ?story? to the team. How did he know there was a problem? What brought him to your team? These questions provide the patient with a venue to speak to the clinician on human terms, without having the burden of recounting vast amounts of medical jargon.

     It is then useful to ask the patient to describe in his own words, what he had been told will happen on the day of surgery. This provides the rehabilitation team with the framework in which the rest of the session will be based. Patients have various levels of coping skills. Many patients will focus upon the diagnosis and forthcoming surgery. Conversely, others may express detailed interest in the rehabilitation aspects of reestablishing voice and/or swallowing. By listening carefully, you can identify what level of information your patient is ready to process in this introductorymeeting. 

     Specific content may vary given the patient?s information needs and readiness for learning. It is good practice to prepare the patient and his family for what they willencounter in the acute post-operative period. For many patients this is their first admission to the hospital. Most patients will encounter IVs, catheters, compression stockings, and feeding tubes for the first time. Many will require intensive care and cardiac or ?wound? monitoring immediately after surgery. The head and neck nurse specialist may provide a basic discussion of suctioning and post-operative stoma care. Reassure the patient the he or she will have close supervision for the first few days after surgery. Discuss the fact that the ICU staff will know that the patient cannot produce voice. While in the ICU environment, writing, pictures and yes-no signals will constitute the means of communication post operatively.

     Once the patient expresses general understanding of the ICU environment, the discussion may naturally move to the alterations in anatomy. The patient should be presented with information that contrasts the differences of breathing through the nose and mouth with breathing through a tracheostoma. Simple line drawings or animated video clips are extremely useful in contrasting nose breathing with tracheostoma breathing. The three primary functions of the nose- filtration, heat-moisture-exchange and olfaction are discussed. At the Milton J. Dance, Jr. Head & Neck Rehabilitation Center the patient is informed that he or she will be provided with an external heat-moisture exchange system in the early post-operative period to help compensate for the altered mode of breathing.

     Patients must be reassured that there are communication options after total laryngectomy --- the artificial larynx, esophageal voice, and tracheoesophageal voice are reviewed. If a patient is scheduled to have a procedure that also involves tongue resection, augmentative communication systems may also be discussed.  It is useful to have sample electrolarynges and voice prostheses available for patient inspection. It is the practice of the Milton J. Dance, Jr. Head & Neck Rehabilitation Center to provide all laryngectomees with an electrolarynx during their hospital stay. Patients are informed that alaryngeal voice rehabilitation will start once the surgeon provides medical clearance.  Videotaped samples of laryngectomees using artificial larynges, esophageal voice and tracheoesophageal voice are available for the patient to view. 

      The educational portion of the pre-operative counseling session concludes with provision of written materials that summarize and reinforce what was presented verbally. These materials may include diagrams and a brief explanation of voicing methods and neck breathing. ?What You Need to Know about Cancer of the Larynx?, published by the National Cancer Institute, provides definitions of medical terms, and summarizes treatment options.  A patient pathway, or chart, summarizing a ?typical? treatment time-line is another tool that reinforces the verbal content of the pre-operative meeting.    Finally, the patient is encouraged to meet with a well-rehabilitated laryngectomee before or several days after surgery.

      Another, essential element of the pre-operative meeting is informal or formal speech and language assessment. Throughout the discussion phase of the meeting, the speech pathologist may form impressions of receptive and expressive language skills, articulation, fluency and voice. This assessment informs the clinician if the communication treatment plan or treatment materials may need to be modified. For example, if baseline-speaking rate is excessive and articulation is impaired, the laryngectomee may require additional intervention. For example, the patient may need to increase oral movements and reduce his speaking rate to have functional voice with an artificial larynx. If the patient has limited tongue movement, he will likely have difficulty learning the injection method of loading the esophagus for esophageal voice. If problems, such as sound omissions or distortions, are noted, an oral-motor examination should be performed. The fit of dentures, if present, should be evaluated. If the prospective laryngectomee has not had a recent audiological examination, then hearing should be screened, as impaired hearing will influence a patient?s ability to monitor his new voice. 

     Some clinicians find it useful to formally record that patient?s voice while reading a standardized passage. This gives the speech pathologist a point of reference with regards to baseline rate and prosody as the patient learns a new voicing technique. It also provides a method of identifying average fundamental frequency, which is helpful in programming or adjusting the pitch of the patient?s artificial larynx.

     There may be many new concepts for the patient to absorb at a time when he or she maybe under a great amount of stress. It is useful to acknowledge this directly. Inform the patient that the information you presented in the initial meeting will be presented repeatedly during the post-operative period and that more information will be available as treatment progresses. Provide additional resources, such as the Self-Help for the Laryngectomy (Lauder, 1993) and Looking Forward- A Guidebook for Laryngectomees (Keith, Shane, Coates & Devine, 1977) for patients to refer to once they leave your office.  

     Patients are individuals and the pre-operative meeting must be tailored to meet the needs of the individual. As a novice clinician I thought the important part of pre-treatment teaching was the provision of accurate, detailed information to the patient. It was my hope that none of my patients would find fault in my information or say, ?No one told me that?. As I have gained experience, I have come to talk less and listen more. This allows me to tailor my teaching to the individual?s needs.  When it comes to the essential elements of pre-operative counseling, Shirley Salmon (Salmon, 1994) said it best ?the only matter of importance is that the laryngectomee and family receive information that is as accurate and complete as they wish it to be?.

References:

*  Groher, M.E. & Gonzalez, E.E, Mechanical Disorders of Swallowing. In Groher, ME (ed), Dysphagia Diagnosis and
   Management, (2nd ed),  Boston: Butterworth-Heinemann, 1992:53-84.
*  Lauder E., Self Help for the Laryngectomee. San Antonio: Lauder Enterprises, 1997.
*  Keith, R.L., Shane, H.C., Coates, H.L. C., & Devine, K.D. (1977), Looking Forward-A Guidebook for the Laryngectomee.
   Rochester, MN:  Mayo Foundation.
*  National Cancer Institute, What You Need To Know About Cancer of the Larynx. NIH Publication No. 95-1568. Bethesda.
   National Cancer Institute, 1995.
*  Salmon, S.J., Pre-and Postoperative Conferences with Laryngectomees and Their Spouses. In RL Keith, FL Darley (eds),
   Laryngectomee Rehabilitation (3rd ed). Austin
, TX: PRO-ED, 1994; 133-148.


   WebWhispers Columnist
                                                                                  
Contribution from a Member
 

Keeping a Seal
Working with a Hands Free

 By Terry Duga

             I have used the hands free valve with the Blom-Singer InDwelling prosthesis for  nine years.  The vast majority of the time, I am successful in getting and keeping a seal. Being a practicing attorney, one that goes into court, being able to talk hands free is important to me.  Here are my views on getting and maintaining a good seal.

            First, we are all different.  I will describe what works for me in the hope that that will help others.  I am not describing ?the only way? to get and maintain a seal, rather I am describing ?one way? to do so.  Not everyone is able to get and maintain a good seal.  Those, who are able to, will discover what ?way? works for them.

            A word of warning, getting and obtaining a good seal, takes patience, practice and persistence.  Do not expect to be successful the first time that you try.  If you are, then consider yourself very lucky indeed but don?t be disappointed if it takes a while to learn what will work for you.  Remembering back, I think it took me at least a month to learn to start with a good seal and, frankly, nine years later, I am still learning new things.

Equipment Needed

            You will need a hands free valve.  I use the InHealth valve.  I have had the valve for almost 9 years.  It cleans with soap and water.  Sometimes I soak it in hydrogen peroxide.

            You will need a housing.  I use the standard housing and sometimes a large one.  I have used the True Seal all-in-one housing and tape with less success. After the reconstruction, my throat tends to push down on the base plate.  This breaks the seal for me.  I do keep some True Seals on hand for emergency use, and I admit to a fondness for them, having been lucky enough to have been a test subject for the prototypes.  I also find them to be very comfortable.  I will be discussing their use. Be warned, however, that  while I have limited success with them, I consider them definitely worth trying.

            If you are not using the True Seal, you will need tape discs.  The discs come in standard and large sizes.  There are several types of tape discs.  At first, I had problems using the standard tape discs, so I used the foam discs.  These seemed easier for me to use.  As I became more proficient with getting a seal, I, again, tried the cheaper regular discs.  There are also various other tape discs, including heavy duty and thin foam ones.

            Rubbing Alcohol. You will want this to dry the area around the stoma to remove oil and moisture.  You can buy alcohol wipes, but, frankly, facial tissue folded into quarters and bottled alcohol is cheaper and works better, in my opinion.  The wipes, however, are handy to have to keep in an emergency repair kit.

            A skin preparation solution is recommended.  I have used Shield Skin and Skin Prep.  For me they work equally well.  Shield Skin wipes are a dollar a box cheaper.  The skin preparations also come in a spray bottle.  I have tried the bottle, but prefer the wipes because of ease of use.

            Adhesive is next.  I use Skin Tac ?H,? which comes in a bottle or a packaged wipe, or the Blom-Singer Brush On Silicone Adhesive.  I have found that both have advantages and disadvantages. The Silicone Adhesive, for me, gives a stronger seal.  This is a definite advantage.  It is thicker than the Skin Tac, and, therefore easier to apply.  The down side, is that you need an adhesive remover, such as Remove to get it off the skin.  In the past, I have found that prolonged use of the Silicone Adhesive, was a bit hard on my skin, which is, however, fairly sensitive and will react to fabric softeners and some detergents so the problem may be mostly me.  I have found that applying a skin preparation does help protect the skin. 


Shield Skin

Skin Prep

 Skin Tac

Skin Tac ?H? cleans with alcohol, which makes it easier to clean.  I t also comes in a wipe which makes it really handy for travel, or to keep on hand when you need to make repairs or to replace a seal at the office or on the road.  It is thinner than the Silicone Adhesive, which makes it run and a bit messier to apply.  It also gives off fumes (it is made with alcohol) which can induce coughing while being applied.  While the Skin Tac adhesive is slightly less strong than the Silicone Adhesive, it has the strange advantage that sometimes if an area weakens and starts to leak a little (not a major blow-out), it may re-adhere if you let it rest for a while. I don?t know why this works but it does for me.  I also find that it is easier on my skin. 

If you use the Silicone Adhesive, you will want an adhesive remover.  Remove, comes in a box of fifty wipes.  It works very well to remove all types of adhesives.  I have even used it to remove residue adhesive from price tags on merchandise, so it has a bonus use.  Be careful to wash the skin with soap and water after using the Remove since Remove left on the skin will break a seal.  After all, it is an adhesive remover. 

You will want something to use to press around the housing to remove air bubbles.  I use the rounded end of the Angled Jansen Gruenwald Forceps, but any rounded end of any forceps or any such object will do, and in a crunch I have used pens, pencils, etc.

Getting the Seal

Preparation of the stoma area is a key to getting and maintaining a good seal.  Dirt, sweat, and oils are the enemies of keeping a seal.  The first thing to do is to wash the area around the stoma thoroughly with soap and water.  I use liquid hand soap (the non anti-bacterial kind) to clean the skin.  Then I use a wet wash cloth to remove the soap.  Next, use a wipe with rubbing alcohol.  The alcohol dries the skin and removes any oil.  This allows for a better seal.  Beware that the alcohol will give off fumes, so hold your breath to avoid coughing while applying the alcohol.  You do not want mucus on your skin.

After a few seconds for the alcohol to dry, wipe on one or two coats (whatever works for you) of a skin preparation, which gives two benefits. First, it provides a layer between the skin and the adhesive that protects the skin from adverse reactions to the adhesive.  Second, that protective layer also provides a better surface to which the adhesive can adhere, which allows for a better seal.  Again, hold your breath while applying the skin protection so you won?t breathe in any fumes that may cause coughing.

After the skin preparation dries (again, a few seconds) apply the adhesive in a thin coat and let it dry.  I have found that if I let it dry for the time it takes me to wash my eyeglasses, run a razor down the two swipes of cheek that are not covered by beard, comb my hair, and attach a tape disc to a housing, the adhesive is dry enough.  Some people are going to want to wait longer.  Do what works for you.  If you are using Skin Tac ?H,? remember to hold your breath when applying so that the fumes don?t induce a cough.

If you are using a True Seal housing, then you may carefully remove the backing, gently center the hole of the housing around your stoma and, while stretching the neck taut, smooth the tape into place.  Gently rub the tape with fingers or a rounded object to remove all air bubbles.

  After the adhesive dries, you can also apply the True Seal housing as described above.  The additional adhesive will give extra strength. Some people are able to successfully keep a True Seal housing in place for more than one day, so it is worth a try.

If using a standard housing, first remove the protective arcs from the one side of the double sided tape discs.  Center the hole of the housing with the hole in the disc.  On a flat surface, press the housing flat on the disc.  Next use your rounded object to further press out all air bubbles.  Air bubbles are the enemy of good seals.  Once the housing is on the tape, gently remove the backing from the tape disc.  Holding the housing by the edges or center, place the hole of the housing around your stoma.  Then gently press the housing into place.  After pushing all around the housing with your fingers, gently press with the rounded object to remove all air bubbles.  The housing is now in place.

I wear a trach tube at all times.  I, therefore, attempt to center the hole of the housing over the hole in the trach tube as closely as possible.  You will find what position works best for you.

I next allow the housing to sit in place without the valve for a few minutes.  Because I usually apply my housing in the morning after my shower, this means that the housing gets to rest while I get dressed.  While I am certain that this rest is not absolutely needed, I believe that it does allow the seal to settle without any pressure, and thus, become stronger.  At any rate, it doesn?t hurt. 

When ready, place a humidifilter in place in the hands free valve, place the cap over the filter, and gently snap the valve into the housing.  You can rotate the valve to whatever position and setting works best for you for talking.  To talk, start with a bit stronger puff of air to close the valve, then speak normally.

I know of one laryngectomee who successfully uses a standard housing with tape discs with just skin preparation and no adhesive.  I have heard him speak and he gets a good, clear, dependable voice.  He must have a very low pressure voice.  I mention this because it is an option.  I don?t think it will work for many, but it does work, and works well for at least one person.

Maintaining a seal 

You have a seal and half the battle is won.  The next step is keeping the seal.  Since air pressure and moisture are the enemies of seals, a blast of air from a cough or having a sweaty neck can break a seal.  Trying to force too much air through the prosthesis, i.e., the laryngectomy equivalent of shouting can do the same thing.

We all know about coughing and sneezing (they are different, but produce the same fast, explosive, blast from the stoma).  Usually, we can tell if a cough is coming and get the valve out to allow for a cough.  We can even learn to stifle a cough or to diminish it.  When you remove the valve, always give support to the housing.  If you are using one hand to remove the valve, then use a finger of that hand to hold the housing in place as you pull the valve free.  This will give some support to the seal and help it hold.  If you are using two hands to remove the valve, use one hand to hold the housing into place and remove the valve with the other hand.

Our WebWhispers member Philip Clemmons advocates preventive coughing.  This entails removing the valve from time to time and coughing even if you don?t necessarily feel you must.  This will clear mucus from your lungs and help to prevent the unexpected cough.

If you do cough with the valve in place, do not panic.  Remove the valve, and use a tissue or paper towel or whatever you use and clean inside the valve so mucus does not pool.  Pooling mucus will weaken the seal where it sits.  If the filter is covered with mucus, do not panic.  Just wipe it off with a tissue.  Do not rinse it.  Rinsing it will remove the salts and anti bacterial medication impregnated in the filter.

When I want to ensure that I have a tighter seal, I use Durapore tape.  There are other similar tapes that can be used.  I like Durapore because it is cloth.  It comes in rolls that are one inch wide.  I cut short lengths and then cut the tape into two strips that are ? inch wide.  I apply the strips around the edges of the housing, half on housing and half on skin.  This gives the seal extra strength.  You can also paint a layer of adhesive around the housing before applying the tape for extra hold but I have not found that to be necessary.

If you have blown a small part of a seal, you can apply some adhesive in the leaking part, push the seal back into place and reinforce the area with strips of tape.  This will give some relief.

If you use a standard housing, there will be some adhesive residue left on the housing after you remove the tape.  Do not worry about the residue.  I have found that the slight build up of adhesive residue actually helps the seal and a housing works better after the first use because of the adhesive build-up.  Do not use Remove on the housing.  Remove will make the silicone become hard.

You will learn what works and doesn?t work for you.  I have found that exercise causes me to sweat, which, in turn, causes the seal to leak.  Remember, moisture is the enemy of the seal.  You will learn to compensate for problems and anticipate trouble, and therefore avoid it.

A different solution may be needed for each person.  Have patience and don?t be afraid to experiment a little to see what works for you. Remember, we really are all different.

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

It?s Biloxi in 2006

     On Wednesday, August 11th, we held a special joint meeting of PALS (Pensacola Association of Laryngectomees and Spouses), and the MS Gulf Coast Nu Voice Club.  In addition to the local group and two SLP's, Penny Bise and Connie Byrne, who normally attend, we had members of PALS, Victoria, another SLP, and Dr. Peter J. Ganley (Ph.D), who is Chief  of Audiology  and SLP?s at the Biloxi VA Medical Center.  Also in attendance were Murray Allan, IAL VP and Annual Meeting chair and Jack Henslee, Executive Director of the IAL who were in to evaluate Biloxi as the site for the 2006 IAL annual meeting.

     Dr. Ganley spoke to the group and informed us of several innovations in laryngectomee care at the VA System in this region which includes hospitals and outpatient clinics from Gulfport, MS to the Florida Panhandle.  First, he mentioned that following the attack of 9/11, the VA went from a private security system to its own security officers who were well trained both as officers and as emergency medical first responders.  In this region, they receive special training in handling the special needs of patients they may encounter, including laryngectomees...  This training includes showing the IAL film "Check the Neck" and class room instruction to augment the film.   Dr. Ganley also mentioned the extensive outreach that the VA has undertaken to reach those veterans that may be eligible for VA care and are not yet receiving it, with particular emphasis on transportation issues.  The DAV and other veteran's organizations have an extensive network of vans all over the country to provide transportation from the patient?s home to VA facilities at no cost to the veteran.  The vans are staffed by volunteer drivers at no cost to the VA .  Most if not all of the vans are donated by manufacturers.  In addition, at the Biloxi VA, there are several shuttles, really over sized golf carts, used to transport people from the more distant parking spaces right to the door nearest their appointment area.  

     After the meeting, Penny Bise took Jack and Murray on a tour of the ENT and speech facilities to show that they are adequate for the Voice Institute.  Jack, Murray and I then went to the Isle of Capri Hotel for an elaborate buffet lunch as guests of the Isle.  The lunch included unlimited boiled shrimp, crab legs, roast beef, ham, turkey, vegetables, potatoes, a great selection of salads and desserts.  The normal prices of the lunch buffet is $7.95 the dinner buffet is even more elaborate and is $12.95 with breakfast around $6.00.

     After lunch, we met with Bob Riley, Director of Convention Sales for the Isle of Capri.  The contract was prepared and then signed on August 12th.

     We will have up to 1200 room nights, with no attrition charged if we don't take all of them, free parking, either self parking or valet, $74 per night per room, with a tax of only 10%, and free meeting and exhibit space.  The rooms and suites will be new since the hotel is adding 400 new units which will be ready in May of 2005, at which time all of the present rooms will be renovated to match.  The present facility is only 12 years old.  The addition will include more meeting rooms, an entertainment center, two new restaurants in addition to the present buffet, steak house, sushi bar and deli.

     Beginning right after the 2005 Boston meeting, I will write in each issue of Whispers on the Web a column about plans and facilities for the 2006 meeting.  I will cover places to see and things to do, side trips to New Orleans, golf and deep sea fishing packages, Aquarium of the Americas tours, Audubon Zoo and D-Day WW II museum tours.

     I look forward to seeing all of you in Boston next year and will be there to answer any questions you may have.

 
   
Campfire Philosophy
                                                                                  
by WW Member Paul Galioni
 

Academic Creep

     We are often judged by intangible criteria called ?academic creep?. This particular 'creep' does not refer to that fifth grade science teacher, or that high school nerd.  It is the concept that we each value ourselves so highly that when we retire from what ever job we have, we feel that it would take someone with much more education than we had to fill it properly.  So, the job that once required a good elementary education now requires a high school diploma. 

     When one sits down and thinks about it ? a good elementary education is all we really need to do most jobs around us.  The most lacking quality is maturity at that time, not knowledge.  And, maturation is really nothing more than experience, the ability to see what one course of action brings, and to see what alternative courses of actions bring.   Then to be able to generalize about the multitude of variables that surround us so that our job and the decisions we make in the job we choose are not deleterious to the welfare of ourselves, others, or the company for which we work or manage.

     Most everything I learned, that was important, I learned in the first eight years of school.  In high school, I learned to type.  But that might not have been real high school since I was forced by my mother to take it in summer school between eighth grade and ninth grade ? so while technically I was not in eighth grade, and I had not started ninth grade, it was given in a building on the high school campus ? so I think I can say that in high school the most useful thing I ever learned was to type.  That took four hours a day five days a week for six weeks. That is 120 hours out of a required 28,000 hours.  We went to school from 8 AM until 4 PM five days a week, 175 days a year for four years.  So it seems about 100 hours of that length of time was actually useful to my future.  Not that the rest was wasted, just that it never applied to anything I ever did in the rest of my life.  Except ROTC ? and that taught me to stand up tall, run and jump, say ?sir?, and become a reasonably good shot.  But I could have learned all of that in about one or two days in boot. 

     So you could take everything academic I learned in four years away from me and it would have made little difference in my life.  As an academic I could argue that it would be a grievous loss ? when, in effect, it is no loss at all.  That is not true of many of the  ?manual? professions ? mechanics, carpenters, electricians, electrical component repair ? those folks learned their life?s work in high school ? and left ready to learn the experience that makes a mechanic good or bad.  I am one who draws no lines between the intelligence of mechanics or brain surgeons ? I sure would like the person working on my car to be as bright and skilled in his field as the person working inside my brain is in his. 

     But we often forget what ?normal? schools were.  A long time ago, anyone could be a teacher ? all you had to be was able to read at about a 4th or so grade level, and be 16 years old or older and you were a teacher ? women could not be married, and could not work at night (wink).  And they taught any way they wanted.  This lead to a great number of different teaching styles and different knowledge bases between schools and school districts.  So states started ?normal? schools where teachers were taught, in one year, the ?normal? ways to teach and the ?normal? subjects to be covered.  So four hours a day of studying tales of the Second Manassas gave way to one hour of math, an hour of reading, an hour of writing, and an hour of history. 

    Those teachers were only high school graduates.  They are the teachers who taught us all our ?elementary? subjects from about the 1880s until the middle 1940s or so ? and in some areas, until the 1970s or so.  High School Graduates with one year of teaching school which was sometimes shortened to four months or six months if they could get work in an elementary school room with successful teachers. 

     Now, in order to teach even kindergarten in the State of California you must complete four years of college with a ?B or better? grade point average over those four years AND take a fifth year (if you are admitted) in curriculum related to teaching AND work 4 hours a day one semester and as a full-time class room teacher the second semester (while completing your full time college load).  That is academic creep.

     It works every where.  The city clerk who dropped out of high school and wrote letters and took minutes retires and thinks: well, I did very well over my 30 years here, and there is so much new to know, I think you must have a high school diploma AND at least a year of experience to do this job.  When that next person retires or moves on after ten or twenty years, they, too, feel that they were fairly exceptional in their abilities to do the work, and the new job description now calls for a Junior College Degree AND one or two years experience ? not to show loyalty, but to show their ability to learn on the job.

     Right now our college requires, for entry level equivalent of clerk-typists, a full two year general education curriculum at the Junior College level, PLUS certificates in word processing, AND one of two or three other areas such as accounting, bookkeeping, data storage and retrieval, and so on. In essence, they now require a Junior standing at a college or university ? 60 units of general education PLUS an extra semester in the field of their choice.  That is three semesters away from a Bachelors Degree ? only one and a half years, and a LOT of extra money.  It is academic creep.  What was once done by a high school drop out or a high school graduate now requires five semesters of college work, of which only perhaps a year is directly related to the field in which they are going to practice. We now require our secretaries to take college history, sociology, a lab science, one semester of a foreign language, and other absurdities.

     It is no longer what you can ?do?, or how well you can do it ? you are judged by the amount of money you or your parents have and the time and devotion you can give to a course of study. 

     That is academic creep.


                          Dutch's Bits, Buts, & Bytes
  Warning, Danger!

     We've all seen lots of those email warnings and virus alerts, but this one tops them all. So I've decided to pass along this little story I just concocted - err, I mean just received from a credible source, for your edification.  This is not a chain letter!  This is not a joke!  This is absolutely true! (Yeah, right...)

--- WARNING, DANGER! ---

I know this guy whose neighbor, a young man, was home recovering from the trauma of his friend's aunt who took her kids to a Burger King restaurant in a major city and they all got bit by snakes in the ball pit.  Anyway, he decided to forget his troubles by having a few stiff drinks down at Mulligan?s, and the next thing you know he awoke in a hotel bathtub full of ice and he was sore all over.  When he got out of the tub he saw a note on the mirror saying that HIS KIDNEYS HAD BEEN STOLEN by Bill Gates, and he could only get them back by dialing 9-0-# and forwarding 5000 emails to a dying girl at Disney World.

THIS IS ABSOLUTELY TRUE!!!  My uncle's friend heard this story from his neighbor who got it from a guy named Craig Shergold who used to work for the American Cancer Society in a major city.

Well, the poor guy immediately tried to call 911 from a pay phone to report his missing kidneys, but upon reaching into the coin-return slot he got jabbed with an HIV-infected needle around which was wrapped a note that said, "JOIN THE CREW".  He was so distraught at this point that he went into the nearest theater and bought a ticket.  It was then that he felt a sharp pain in his left shoulder blade.  The people behind him got up laughing and tossed a wadded-up paper ball at him as they ran out.  When he uncrumpled the paper, it said "WIN A HOLIDAY" and was signed by Jessica Mydek.

THIS IS NOT A JOKE!!!  I have a friend who works next door to the police department of a major city and he heard it from his elderly aunt.

The poor man, having no kidneys and infected with a dread disease, stumbled into a nearby Neiman Marcus cafe and ordered a plate of cookies to console himself.  The cookies were so good, he asked for the recipe and was told that it would cost "two fifty".  When he received his bill, there was a charge for 250 dollars.  Furious, he fired up his laptop and sent an EMail to his lawyer.  It was then that he noticed his Palm Pilot was infected by the Budweiser screen saver virus.  A "flashing IM" appeared on his AOL screen, and without thinking, he clicked on it.  Instantly, hackers stole his password and began downloading salacious photos of Nina Tottenberg onto his hard drive.

So anyway, the poor guy tried to drive himself to the hospital, but on the way he noticed another car driving along with its headlights off.  To be helpful, he flashed his lights at him and was promptly shot as part of a gang initiation in a major city.  His arm was bleeding badly, but he was able to make it into the mall parking lot.  Just at that moment, he saw two guys with black hoods stuffing his wife into a van.  Apparently they had told the woman there was a dying baby in the parking lot and asked for her help.

THIS IS NOT A CHAIN LETTER!!!  Please forward this urgent message to every one you can, and spread the news that the Take-A-Bath Foundation will donate a pair of Nike sneakers to everyone at Disney World, but only if you send it to 1000 people.  So don't be a thoughtless jerk - it only takes a minute of your time to spread this chain letter, and it could be true!
********
GET THE POINT??  I HOPE SO!!

 

   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) ...

FANBOY

Though annoying and often disruptive, Fanboy is a relatively harmless
Warrior because his interests and knowledge are strictly limited a
single obsession, such as a particular video game, celebrity, television
show, movie, sports team, computer operating system, "prosthesis" ?
almost anything, really.  Fanboy?s compulsive fixation makes him very
easy to identify, but it also arms him with supernatural tenacity in
defending his fetish.  A suggestion of a minor improvement to the
object of his adoration or benign criticism of it immediately brings
down a cascade of virulent abuse.  Indeed, it is almost impossible to
have a reasonable discussion about his subject because anyone not
in 100% agreement with him will get bludgeoned with accusations of
ignorance or malicious intent.  CAUTION: ANYONE can become a
Fanboy, but the warning signs of a larval Fanboy are subtle and easily
overlooked.  Are you a little hasty to defend, say, MSWord?  Are you
increasing impatient with people who aren?t fans of your favorite
sports team?  Has it become important to you that everyone
understands that golf is superior to tennis?  If so, you are standing at
the edge of the abyss ? step back before it?s too late.

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


 

Preview our 2005 Cruise departing Boston for New England and Canada ...
sailing immediately after IAL 2005 concludes.
Click HERE



   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 12 new members who joined us during August 2004:
 

Carol BeVille - SLP
Vinton, VA
Henry Colman
Pulaski, VA
Sylvie Dicaire - Caregiver
Timmins, Ont., Canada
Michelle Ford - Vendor (InHealth)
Carpinteria, CA
Beth Hagle - SLP
Raleigh, NC
Frank Hancock
Englewood, CO
Tim Hoagie
Citrus Heights, CA
John Iagmin
Watauga, TX
Gary Mckinnon
Palatka, FL
Barbara J. Vinson
Texas City, TX
 
Craig Walker
Xenia, OH
Georgia West
Woodbourne, NY
 



 
WebWhispers is an Internet-based laryngectomee support group.
  It is a member of the International Association of Laryngectomees.        
  The current officers are:
  Murray Allan..............................President
  Pat Sanders............V.P.-Web Information
  Terry Duga.........V.P.-Finance and Admin.
  Libby Fitzgerald.....V.P.-Member Services
  Dutch Helms...........................Webmaster
      

  WebWhispers welcomes all those diagnosed with cancer of the
  larynx or who have lost their voices for other reasons, their
  caregivers, friends and medical personnel.  For complete information
  on membership or for questions about this publication, contact
  Dutch Helms at: webmaster@webwhispers.org   

 

Disclaimer:
The information offered via the WebWhispers Nu-Voice Club and in
http://www.webwhispers.org is not intended as a substitute for professional
medical help or advice but is to be used only as an aid in
  understanding current medical knowledge.  A physician should always be   
consulted for any health problem or medical condition.



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



  ? 2004 WebWhispers
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can be found on our
WotW/Journal Page.