Whispers on the Web - November 2005 · attache', a narrator, teacher, emcee for various events, and...

3/30/08 8:04 PMWhispers on the Web - November 2005

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November 2005

Name Of Column Author Title Article TypeMusings From The President Murray Allan Profile Of Dutch News & EventsWeb Whispers Columnist Marianne Peereboom Dutch Assn Larys ExperiencesVoicePoints Dr. Jeff Searl ES Speech Today Education-MedNews You Can Use Scott Bachman Maintain Your Records ExperiencesLiving The Lary Lifestyle Joan G. Burnside Chapter 9 Education-MedBetween Friends Donna McGary Look Inward ExperiencesRoger's Ramblings Roger Jordan Katrina ExperiencesBits, Buts, & Bytes Dutch Computer Tips ExperiencesNew Members Listing Welcome News & Events

Murray's Mumbles ... Musings from thePresident Profile of a WebWhispers ExecutiveCommittee Member

Having profiled Pat Sanders, Terry Duga, and Libby Fitzgerald it is now time to mention theman that made WebWhispers possible. I can say without reservation that without him youwould 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 - InternetActivities and the permanent Webmaster "until fired" as he likes to say. Additionally, he was thefirst 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 hadbeen full of activities that required a "normal" speaking voice. He was bornand raised near Cleveland, Ohio; received his BA in German and Historyfrom Heidelberg College and after limited graduate work at Ohio andOklahoma Universities finally received his MA in National Security Affairsfrom the Naval Postgraduate School in Monterey, CA. He was primarily amilitary pilot, a Vietnam veteran who flew 339combat/combat-reconnaissance missions as an O-2A Forward AirController (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 airattache', a narrator, teacher, emcee for various events, and even sangin choirs, choruses and barbershop quartets. His entire life hadrevolved around the use of his natural voice, perhaps more thanmany of us. The loss of it was devastating and the thought of neverbeing 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 causesome personal embarrassment. Dutch once wrote, " I simply could not imagine going throughlife without a VOICE. Thus, being told that a laryngectomy would be necessary, while I was stillsuffering from going through a divorce and having the next relationship end with a canceledwedding, 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 tolive. Luckily I got help and spent over a month in a military mental health facility "getting agrip 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 apersonal weakness to some. This didn't bother Dutch. He told the truth, the whole truth andnothing but the truth and that's the mark of Dutch Helms. And his honesty, steadfastness, andintegrity show through in all the things he has done in his work to create the beginnings ofWebWhispers in 1996 with a small group of laryngectomees. In 1998 WebWhispers was officially off the ground with an elected Executive Committee and theword spread and the larys came. In just a few years this web site had more than 1200 membersincluding, larys, caregivers and professionals. Dutch, through WebWhispers, has inspired countless numbers of individuals battling thisdevastating disease. He has made hundreds of cyber space friends and now as permanentWebmaster works tirelessly and relentlessly to supply the needed information, support, andguidance to those initially diagnosed with laryngeal cancer and to those living life as alaryngectomee.

Dutch has his home in El Lago, Texas, southeast of Houston near Johnson SpaceCenter, where, in addition to THE computer, he has many hobbies including thedelicate work of hand crafting 54mm military miniatures (what some erroneouslycall "toy soldiers"). His first love, of course, is WebWhispers and the amount oftime and effort he has spent organizing it and operating it every day is trulyamazing.

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 [email protected]

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 startswith coffee and cake, then has an official part which is never more then one and a half hour. Sometimes wehave a speaker but this year we had the promotion video of the lary swim clubs (2) we have here in TheNetherlands. 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 coversa 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 wantedto 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 wasof people from the South West of The Netherlands, which is famous for shrimp and fish. One lady was alldressed up in the costume they wear there and she was peeling the shrimp. Another booth of a club of theNorth showed the famous 11 cities skate tour, had sausage and candy they make there. Another one has acity in the area which is the oldest city in the Netherlands. Their city came from a Roman army campthousands 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 cabbagethey 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 inmy area. We also have two villages Volendam and Marken where people still wear the traditional clothing. Myhusband 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. WhatI 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 goesfrom mother to daughter. They have a costume for the time of the year, when you getmarried, because someone passed away in the family and even that goes in stages. Ihave not had real Marken traditional clothing on for 23 years. Last time was when ourmarriage 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 aquestion the people had to answer. The booths had a number and were not markedwhere they came from so the people had to guess what the clue was and where thepeople came from because of the way the booth was set up. I was dressed in thisclothing and people had to guess that. In another booth they had to guess what kindof a fishing net it was, how many candies ( special) were in the bowl, how much thecookies ( special) had cost and so on. It was a huge hit, there where 365 people at themeeting and almost 200 had sent in the form. The person who had the most rightanswers had a prize and also the second and third runner up. Also, the best lookingbooth according to a jury won a prize.

My buddies and I spent a lot of time getting the stuff together. We have so manycultural things in the area, we had to make choices. If we had used names of cities, then people would knowright away. We used pictures of statues, posters, flower bulbs to hand out, we had Navy Uniforms on apuppet, 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 undersea level). We got a lot of information and DVD?s of the company that makes the plans to protect us from thesea. They built up the dunes, bringing in dams to guide the water another way so it won't wash away thebeaches.

We had a windmill model, an old model of a train that used to runfrom one city to another but now serves as a tourist attraction and wehanded out 8 pounds of Edam cheese. We also had a model of aship that farmers used in the early daysto bring potatoes, cabbage and other



veggies to the place where they sold it. This was an auction place and theybrought it all in by ship. The water wentthrough the building so the ships camein, the people bought the stuff, theyunloaded it on the other side and out theywent again. This was VERY special forme because my Grandfather used to

come to this place and, as little girl, I had been there with him. I must have been 3or 4 years old but I still remember it. The place is still there and is a museum nowwhere people still can buy things. We got pictures of the old days and one ofthem had my Grandfather on it. Almost everything we had in the booth was givento us by either companies (bulbs and sauerkraut) or museums and people loanedus their models of old Dutch houses and the Navy uniforms. We only bought thecheese and the sand for the dunes.

I also sent in a picture of my two children dressed up in traditional Markerclothing. My son wears the male outfit that adult men wear. My daughter is wearing the clothes that girls useto wear when they were getting married but this particular outfit is at least 200 years old and people were a lotsmaller 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, gotout 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 ( [email protected] ) Hearing and Speech Department, The University of Kansas Medical Center MS3039, 3901 Rainbow Blvd., Kansas City, KS 66160

Esophageal Speech TodayJeff Searl

University of Kansas Medical Center

Two events served as the impetus for the review that follows. The first was a referral of a laryngectomypatient. The second was my reading of an article that is now 13 years old. Bear with the long introduction thatsets 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 ofwhat 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 atracheoesophageal (TE) voice prosthesis or an artificial larynx (AL). As it turns out, esophageal speech was notthis woman?s initial choice for a communication option but, to be honest, she really had no idea whatesophageal speech was. This lack of knowledge about esophageal speech is not unique among the newlylaryngectomized who most often seem to be told more about TE and AL speech than ES (although this is notuniversally 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 intimatelylinked to Doris? situation. In the article, the authors were asking: If given a choice, what alaryngeal voiceoption would patients prefer, TE or esophageal? There are other studies that ask patients (and others) theirpreferences for the different alaryngeal communication options. In these other studies, subjects are usuallypresented with different scenarios or audio samples of voices and then asked which they prefer. Oralternatively, studies will ask a group of TE speakers how well they are doing in their life, how good they thinktheir speech is ,etc.; then, do the same with a group of AL users or esophageal speakers and compareresponses. In the study by Quer and colleagues, the patients were actually allowed the opportunity to becomeproficient at TE and then trained to the best of their ability to use esophageal speech. Of their 23 TE speakerswho were also trained to use esophageal speech, 16 decided to remove their TE prosthesis at the conclusionof the study, opting for esophageal speech. This represents 70% of the group. The really interesting thing wasthat this group that switched to esophageal speech indicated that their TE voice was better than thereesophageal 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 esophagealspeech. She hardly knew anything about it. In her case, she had a TE puncture done as a secondary procedureabout 18 months prior to seeing me (she used an AL, pre-puncture). She had actually been successful at usingher TE voice for several months. However, the tissues of her neck started to do some funny things. Her TEfistula tract migrated down so that it eventually was about 1 ? inches below the lower rim of the stoma. This, ofcourse, made care of her indwelling prosthesis nearly impossible. Her stoma also started to shift to the leftside of the neck. And she had persistent problems with stoma shrinkage (she?d had two stoma revisions toincrease the size to no avail and used a laryngectomy tube to stent the stoma at night and at times during theday). Her neck tissue was not stable. The prosthesis was pulled and the fistula tract allowed to heal in thehopes 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 leftcheek. Radiation changes and significant keloid scarring on the neck made neck placement untenable forgetting good AL resonance. She had lukewarm interest in esophageal speech after I explained it to her, but shewas willing to try. She also needed work on cleaning up her AL use so I offered her that as well. As it turnsout, she is wonderful at esophageal speech, not proficient yet but a quick study, who I have every hope willeventually be able to utilize ES at her whim. Ten days ago, Doris had a routine follow-up with her ENT and Iwas able to go to that visit with her. Her neck tissue has settled down now and re-puncturing is a possibility ina few more months according to her ENT, if Doris is interested. She?s not sure if she is. Doris is a real-lifesituation of the study by Quer and colleagues. She has an opportunity that very few patients get in that she willhave had an opportunity to know what it is like to actually use esophageal speech, TE speech, and artificiallarynx speech. Most of the folks I work with might get the chance to compare TE and AL use because we trainall of our folks on an AL. Now I am starting to wonder how we can incorporate a true esophageal speechlearning 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 whichWestern medical practices dominate and TE speech is often considered the standard of care. I recognize thatthere is a risk of sounding ?anti? TE or ?anti? AL in what follows. That is not the intent at all. TE speech hasrevolutionized the rehabilitation of individuals who undergo total laryngectomy. I do most of my clinical workand much of my research on TE (and AL) speakers. And I, like others, recognize the significant advantages thatTE speech has (although there are disadvantages as well) over esophageal and AL speech. However, the SLPhas an obligation to present the advantages and disadvantages of each option, evaluate each patient?sabilities 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 asthey 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 ofesophageal speech. He alluded to the fact that this method of alaryngeal speech is becoming less and lessutilized. In some respects, this is a follow-up to Jim?s thoughts. This not a call for preserving esophagealspeech like a relic in a museum. Rather, it is a call to question whether there is a reason to revive interest inesophageal speech as a true option for our patients with a laryngectomy. It has remained that in somelocations, but not many. As indicated below, it seems likely that as a prior generation of SLPs trained to offeresophageal 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 whoutilize esophageal speech have historically served a role in training other laryngectomees in this method. Asfewer and fewer laryngectomees utilize esophageal speech, opting instead for AL or TE speech, the pool ofpotential 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 speechrelative to tracheoesophageal speech. However, the introduction of tracheoesophageal puncture (TEP) in the1980?s (Singer and Blom, 1980) has led to a significant shift in post-laryngectomy speech rehabilitation. Thishas been particularly true in countries with predominantly Western medical practices. The increasing popularityof TE speech since its introduction is presumably related to several factors. Undoubtedly, the high successrate reported for re-establishing communication fairly quickly after surgery has had a major influence. Thereare many articles documenting the quick rate of acquisition of TE speech by a large percentage of folks thatattempt it (see the following items in the reference list: #2-5). The high success rate for TE speech is in starkcontrast 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 themost 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. Afterdiscussion and evaluation of the patient, the method of communication that best meets the person?s needsand abilities is selected. Gress goes on to state, however, that the ideal situation is often not attained inpractice 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 expectationsand attitudes toward the various alaryngeal speech options based on the way that they present them topatients (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 orpursues.

In our clinic, we begin from the following premise: AL, ES, and TE speech are not pitted against oneanother with the goal of crowning one as more superior than the others. Rather, the clinician?s goal is toidentify the most appropriate alaryngeal communication options for an individual based on that person?sabilities, 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 alaryngealspeech rehabilitation and was regarded as the ?gold standard? for many years. Artificial larynx speech wasanother option but a negative bias against AL use persisted. This has largely been refuted, and clinicians andpatients alike generally see the merits of AL usage for many laryngectomees. Ironically, with greateracceptance of AL speech and the advent of TE speech as a highly successful third option, ES has become theleast 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 theprimary 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 beappropriate, and in some cases preferred, for certain individuals. The issue is in determining who theseindividuals 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 tablesare broken down into issues regarding how the speech is produced (Table 1), what the speech generallysounds like (Table 2), and then therapy and other issues (Table 3). The intent here is not to engage in detailedcomparison 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 beindividuals 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 voiceproduction, preferring to rely solely on their own body to speak. This eliminates the worry of mechanical orprosthetic failures (. Other patients might not have the eye sight, manual dexterity, or a capable caregiver toassume daily cleaning and care for a TE valve. Still others might have tissue that does not allow a stable TEfistula (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 selectcircumstances (e.g., quick social niceties such as ?thank you,? ?bye-bye?, etc.). Still others, may learn ES inrecognition of the fact that sometimes AL and TE speech are problematic. For example, an AL user may findthemselves with a broken device without a back-up. A TE user with a malfunctioning indwelling valve may bewaiting for some period of time to get in to see the SLP. Whether it be a matter of days or only hours, alllaryngectomy speakers should have a back-up means of communicating. Esophageal speech could serve thatrole.

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 visualacuity or hand/arm control. For some individuals, the freedom to use both hands for other tasks while talking isparticularly important, perhaps for their occupation or hobbies. Hands free speech is certainly possible with TEspeech if a hands-free valve is used. However, this requires additional hardware with associated daily care thatmay 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 speechsounds?. That is not to say that ES is a poor option. However, we do know that there are some limitationsabout esophageal speech that can be problematic, at least for some people or some situations. It should bekept 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 anyacoustic or perceptual measure. However, the research literature suggests that TE speech is generally regardedas being the most similar to laryngeal speech (refs#: 18-24). Additionally, the literature generally favors TE overAL and ES in terms of intelligibility (refs#24-28) and listener preference (refs#2, 27, 29; but see refs # 30-32who found something to the contrary). Remember though, that these are results when we look at groups ofspeakers. We have many, many, folks who are excellent ES (and AL and TE) users. And we have poor speakersusing each of the three options as well. Some research suggests that the overall intelligibility of the speech ismore 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? Someanswers to this question are more obvious and have been alluded to above. Availability of ES and/or AL isnecessary for individuals who do not meet the pre-requisites for TE voice production or who cannot tolerateany 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 aresuccessful at using it. Initial success rates reported in the literature have ranged from ~30%-90%, althoughmost have fallen toward the top half of this range (refs#: 5, 33-37). However, not all are successful at it, andthe follow-up data suggest that perhaps 5% to 30% of individuals who had initial TEP success are not using TEspeech at 9 months or more (refs#: 2, 35, 36, 38). The reasons for this might be many and it could be arguedthat 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 forthe need to have other alaryngeal speech options available.

Using TE speech acquisition rates to argue for maintaining ES as a viable third alaryngeal speech optionis 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 thelong-term follow-up data for TE speech. In fact, the low success rates in acquiring ES were a major drivingforce behind the development of the TEP procedure. However, not all individuals can utilize TE speech andsome individuals can learn ES (or AL).

There is a final and valid consideration, alluded to above, regarding the relevance of ES in this era inwhich TE speech is often held out as the new standard of care. Some patients may seek out ES as acommunication option not because they fail at or lack pre-requisites for TE or AL speech but simply mayprefer ES. We have very little data available in which the various methods of communication are compared



MechanicalDevice/ProstheticRequired

Hand OccupiedDuring Voicing

Yes/ No(some are able touse a hands-freespeaking valve)

Interference withOral Movements

No specialrequirement No special

requirement

Voice Production:No special requirementusually neededProsthesis Care:May needcaregiver supportif visual acuity isreduced

Voice Production:Requires ability tomanually occludestoma unlessusing a hands-

within the same speakers. The study by Quer, Burgues-Vila and Garcia-Crespillo that I mentioned in theintroduction is intriguing. As they stated, they sought to answer the question: ?What type of voicerehabilitation would our patients prefer if they could make a choice between tracheoesophageal andesophageal speech?? (p.190). Seventy percent of there group opted for ES even though they felt like their TEvoice was better. This suggests that at least some patients would make a decision on their preferred methodbased 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 fullyinformed say about which communication option(s) they can utilize? Personal communications with SLPsacross the United States in the past two years suggest that fewer and fewer clinicians are knowledgeable aboutES 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 viablecommunication option to patients will continue to decrease. More studies that allow patients to directlycompare the three options and then chose their preferred method would go a long way toward directing theSLP field in terms of the emphasis that should be placed on ES research and training in the future. We agreewith Doyle (2005): ?Clinicians must fight the urge to dismiss any of the post-laryngectomy communicativeoptions 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 unableto do so, perhaps because of how the top of their esophagus functions after the surgery or for a variety ofother reasons. Likewise though, TE and AL are not for everyone. Informed choice is ideal. Better yet would bethe opportunity for an individual with a laryngectomy to actually experience each of the options in sufficientdepth to inform their decision, although this will not always be feasible. As a researcher and clinician thechallenge may be to figure out a way to better predict early on who is likely to succeed in learning esophagealspeech. 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 thespeech is produced.

Speech Process Issues Artificial LarynxSpeech

EsophagealSpeech TE Speech

Yes No Yes

Yes No

Yes/No(use of an oral

adaptor can causeinterference)

No No

Visual AcuityRequirement (reduced visual

acuity can generallybe tolerated)

Requires ability tohold, activate, and



free valve (whichitself, requires finemotor controlfor attachment)Prosthesis Care:Fine motorcontrol neededunless caregiver

Finger/Hand/ArmDexterity Requirement

manipulate devicecontrols (use ofwithin-the-oral-

cavity devices canmitigate thisrequirement)

No specialrequirement

assumes the duty

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

Speech Product Issues Artificial LarynxSpeech

EsophagealSpeech TE Speech

Voice quality 1, 2, 3, 4, 5

Mechanical/unnatural;less preferred thanlaryngeal; generally

less preferred qualitythan ES or TE

Glottal fry, hoarse,rough, wet,

breathy; lesspreferred than

laryngeal and TE

Glottal fry, hoarse,rough, wet,

breathy; generally,less deviant thanES and EL, butless preferredthan laryngeal

Speaking FundamentalFrequency Mean 6, 7, 8, 9, 10

Determined by deviceused ? some are

adjustable

Lower than TESand laryngeal

speakers

Lower thanlaryngeal

speakers, but notas low as ES

Intonation/pitch variability11, 12, 13, 14, 15

Restricted primarily bythe device used

Restricted relativeto laryngeal and

TEP; greater thanEL

Restricted relativeto laryngeal;

greater than ESand EL

Speaking IntensityMean3, 6, 9, 16, 17, 18, 19

Adjustable ?potentially louder thanES, TES and laryngeal

speech

Less intense thanlaryngeal, EL and

TEP

Variable from lessthan, equal to, to

greater thanlaryngeal; greater

than ES

Speaking Rate9, 20, 21, 22

Equal to/possiblyfaster than laryngeal,

ES and TEP

Slower thanlaryngeal, EL, and

TEP

Comparable tolaryngeal; faster

than ES

Speech Intelligibility23, 24, 25, 26, 27

Less than laryngeal,TE and ES in high

signal-noise situationsHigher than TE and

ES in Noise

Less thanlaryngeal and TE,

generally

Less thanlaryngeal; Greaterthan ES and EL

(except in noise?)

Overall "success" inattaining useable speech25, 28, 29, 30, 31, 32, 33

Generally, a fairly highsuccess rate (largepercentage of users)

Generallyconsidered tohave the lowest ofthe three

Typically higherthan ES; alsohigher 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 therapyprocess and other issues.

Therapy Processand other Issues

Artificial LarynxSpeech Esophageal Speech TE Speech

Onset of TherapyPost Surgery

Earliest of thealaryngeal options

(within 2-3 days post-surgery)

Later than EL, similarto TEP

Later than EL, similarto ES

Duration of theTherapeutic Processto Functional Speech

Shorter than ES;similar to or longer

than TEP

Longest of thealaryngeal options

Shorter than ES, oftenshorter than EL

Cognitive Demandsfor Learning Comparable to TEP Somewhat greater

than EL and TEP Comparable to EL

CostLess than TEP;

similar to or less thanEL?

Less than TEP;similar to or more

than EL?Most Expensive

Availability ofQualified SLPServices

In urban settings andhospitals, SLPs are

generally available toprovide this service;

services in ruralareas are less

commonly available(though more so than

for ES and TEP)

Fewer SLPs familiarwith ES training these

days in any setting

In urban settings andlarger hospitals, SLPs

are generallyavailable to provide

this service; servicesin rural areas for TEP

care are much lesscommon

On-goingmaintenance ofdevice/prosthetic

Yes (infrequent) No

Yes (daily cleaning;removal & reinsertion

of prosthesis bypatient or SLP)

Reliance on SLPpost-acquisition ofspeech

No NoYes ? particularly if

using indwellingdevice

Reference List1. Singer and Blom, 19802. Blom, Singer & Hamaker, 19863. Cantu, Ryan, Tansey & Johnson, 19984. Clements, Rassekh, Seikaly, Hokanson & Calhoun, 19975. Hamaker, Singer, Blom & Daniels, 19856. Anderson, 20007. Gates, et al., 1982



8. Hillman, Walsh, Wolf, Fisher & Hong, 19989. Koike, Kobayashi, Hirose & Hara, 200210. Schaefer & Johns, 198211. Gress, 200412. Frowen and Perry, 200113. Brown, Hilgers, Irish & Balm, 200314. Salmon, 200515. Fujii, Sato, Yoshino, Umatani, Ito & Hashimoto, 199316. Shenoy, Ashok, Premalata, Prasad, Nanjundappa & Kumar, 200017. Tsai, Chang, Guo & Chu, 200318. Bertino, Bellomo, Miani, Ferrero & Staffieri, 199619. Debruyne, Delaere, Wouters & Uwents, 199420. Eadie & Doyle, 2004 21. Globlek, Stajner-Katusic, Musura, Horga & Liker, 2004 22. Robbins, Fisher, Blom & Singer, 198423. van As, Koopmans-van Beinum, Pols & Hilgers, 200324. Williams & Watson, 198725. Ainsworth & Singh, 1992 26. Doyle, Danhauer & Reed, 1988 27. Goldstein et al., 198428. Max, DeBruyn & Steurs, 199729. Miani, et al., 199830. Bridges, 199131. Sedory, Hamlet & Connor, 198932. Trudeau, 198733. Geraghty, Wenig, Smith & Portugal, 1996 34. Kao, Mohr, Kimmel, Getch & Silverman, 199435. Lentin, Williams & Sellars, 199536. Mehta, Sarkar, Mehta & Bachher, 199537. Singer, et al., 198138. de Raucourt, et al., 199839. Anderson, 200040. Gates, et al., 198241. del Rio Valeiras, et al., 200242. 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 RECORDSThe Internet often can be like a Second Hand Store or a rumor mill. Some things seem to go round and roundand 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 naturaldisaster can occur anywhere, it is incumbent upon all of us to maintain our records. It should be added toyour ?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 onthem. 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 anyonewho might be handling your check as it passes through all the check processing channels won't have accessto it.



4. Put your work phone number on your checks instead of your home phone number. If you have a PO Boxuse that instead of your home address. If you do not have a PO Box use your work address if that isappropriate and will not create issues at your workplace. Never have your Social Security number printed onyour 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 andcancel if necessary. Keep the photocopy in a safe place. A photocopy of your passport is also a good thingto have when traveling here or abroad. This is critical information to limit monetary damage in the event yourwallet 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 numbershandy 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. Thisproves 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 organizationsimmediately to place a fraud alert on your name and Social Security number. This alert identifies yourpersonal 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 spotyour 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 listsvoice prosthesis, neck breather, mild htn. It looks very cluttered and not very readable. When I reorder I willspecify 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

http://www.medicalert.org/



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 tomaintain my weight. I also had a lot of mucus complicating my speaking. After I cut way back, I saw a greatimprovement 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 threateningto Larys. After all, why bother with a laryngectomy, if you won?t bother with this basic precaution? Anotherreason 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 amaintenance 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 youresophagus that are collecting mucus and causing the problem. Try pulling your head back or turning it to theleft 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 yourSLP 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 dipit 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 ata 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 thatI discovered another way to make up for my food deprivation. Since then, I?ve also found that the cheaperbiscotti 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 willhelp 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 theway. If you?re in the habit of tossing your head back to swallow pills, you could be making the opening toyour 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 anelectrolarynx, exhaling has nothing to do with speaking. Control it by exhaling more softly. The noise is verydistracting to the listener. If you can?t make this work by yourself, ask your SLP for help in finding a remedyfor 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 soundyou would have liked to say. Also if you take a tiny pause, just before you say the word, it prevents the lastsound of the previous word from becoming the first sound of the H-word. The last and best idea is to start tomake the K sound, but don?t quite complete it. It may sound a little like a foreign accent. In fact, if youlearned to make a French R sound in high school, you?ll have the idea. I?ve been told that you?ll get it moreeasily 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 phrasesfor 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 earlydays after the surgery. But we can. The best repayment can start with doing things for ourselves as soon aspossible, even if only part of it and even if it seems to take forever. Relieving any part of the burden is goodpayback. Or maybe there is some little thing that has always been your caregiver?s job. Try doing that. Notonly 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 outbecause one person is obviously the secretary, valet, water bottle carrier, groomer and dispenser of tissuesand snacks for the other. And this is even before diagnosis and treatment! You can see how easy it is to getover your head in debt to your caregiver. (Hope you?re not the guy whose wife is still shaving him, after he?swell 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 ifthey offer free shipping for on-line ordering. At $12 a pop, which insurance companies and Medicare will notpay, 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 anythingto compensate for the lost H sound? Do you have your MedicAlert bracelet yet? And how?s the mucusinterference coming along? Your notebook pages are a great place to write and draw, and to staple or paste inyour WebWhispers e-mail. Believe it or not, in the weeks and months ahead, you?ll enjoy looking back atthese.

BETWEEN FRIENDS Donna McGary 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 amgrateful). I know I should appreciate the Servox technology (and I do) and I should be happy that most of thepeople understand me very well, most of the time (and I am happy in a rueful sort of way). But I am notcontent and what?s worse, I am fast getting sick of the sound of my own voice. When it was all new and I hadbeen without a voice for the better part of 18 months, I loved my new voice and my family and friends werethrilled with it. We made fun of it and me and my non-stop chatter in the same relieved way people makedelirious 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 comfortablewith ?my voice?, I am becoming increasingly uncomfortable and impatient. I loathe talking on the telephone. Itolerate it grudgingly with family and friends and avoid it if at all possible (even when not practical) withstrangers. I am not becoming a recluse. Far from it; since moving back to my home state of Maine I amspending more time with my family and old friends and I am still working and maintaining contacts andfriendships 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 takethat damned cord from off around my neck and stick my Servox in the battery charger. I have found myselfthinking, ?Good, now I won?t have to talk at all until tomorrow.? There are days I wake up thinking ?I don?thave to talk to anyone today?. Before you start wondering if I am depressed or some such other thing, youneed 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 andsnorting ?As if!? And, certainly, I am not now nor ever will be, a true introvert! But I am becoming moreintrospective. I like the sound of my own voice in my own head. It still sounds like me with out all thatdistracting buzz and lack of inflection. I can sing in my head, I can do voices and accents and tell poignanttales and funny stories. I can project my voice across a crowded room and make you sit up and listen. I amso 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 BenAmes Williams. Come Spring is an historical novel published in 1940 (and still celebrated in our neck of thewoods) about the early settlers of Union, Maine. It follows one family?s struggles from their sea passage fromEngland through the Indian and Revolutionary Wars. I highly recommend it even if you never have visited FortWestern 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 noware 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 heknows he?s in love and marrying; and you can see something new in his eyes, deep and strong. That?s like acandle when you first light it, standing up so straight and white and slim and fine; and the flame?s real prettyto 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 shapelike 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 hardlyanything 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 asyou feel?. But that is a lie. You are as old as you are and no matter how young you act or dress or think orsound, you cannot cheat time anymore than I can cheat cancer. It has taken its toll, just like time. My face isno longer smooth and my voice is no longer sweet. But in my mind?and on the page?I can still summon thatvision 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 andthe new eloquence. It is, unfortunate perhaps, that the old voice could not speak with the new eloquence, butthat 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 wouldbe expected to see along the Gulf Coast when IAL 2006 would be held in Biloxi, MS. We went from beingexcited about the great plans for next year to mourning the tragedy the Katrina wrought. We hoped Roger hadfared better than what we were seeing on TV with the coverage of Katrina and we did receive this messagefrom him as soon as he was able to return home and communication was available. (By the way, IAL 2006 willnow 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 upfor 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 Sept21st. Had a lot of trees down in yard but only minor roof damage and onesmall broken window in master bath over tub. Power had been restoredbefore we returned and water was safe to drink but the destruction in thisarea was unbelievable. Diamondhead is a small community of about 4500homes and condos. We lost an estimated 10 to 12 thousand trees, mostlylarge pines. The smaller trees were more flexible and fared better. I had nopines on my lot, but had 5 from the lot next door in my yard, all over 100 fttall. Fortunately, all missed my house. I also lost 2 pin oaks and one verylarge live oak. Diamondhead has a lot less shade than before Katrina!

The beach front highway is still restricted toemergency vehicles and residents of the immediate area so I have not personallytraveled on it, but have been close enough to see what happened and have seenmany local TV reports (Rabbit ears to the rescue.) The highway itself buckled inplaces. All of the casinos along the Gulf were destroyed except for the BeauRivage, the largest and newest, and it suffered extensive damage but announcedyesterday 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 theywere before Katrina and all of them plan to do so as quickly as possible. None of the hotels suffered extensivedamage above the first two floors, in fact most are being rented by FEMA for temporary housing of emergencyworkers. The Isle of Capri announced yesterday that they will move the casino to the hotel building until a newfacility can be built and estimate 9 months for completion. The state also announced plans to award contractsfor the two major bridges on Hwy 90 to be awarded by December with completion by summer of 2007. Butplans 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 fullyoperational 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 thebirth of another grandson to her son and his wife living in London, so she flew to the UK to greet the newarrival.) None of the members of the Gulf Coast Nu Voice Club were injured, although several had extensivedamage to homes and apartments.

Hurricanes can be a bit more devastating than even I thought. My previous guide had been Betsy in 65 andCamille in 69. Someone recently commented that Camille killed more people in 05 than she did in 69, and it isquite true. I can't count the times I have heard that, "My house didn't flood in Camille, so I thought I would beOK." 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 oneach side, so many have had the habit of moving their vehicles from nearby homes and businesses to theshoulders of 603. Those vehicles were ALL washed into the ditch on each side of the road. They looked like apoorly 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 ofweeks ago. Thursday, the clean up crews from Diamondhead arrived to pick up the street side debris. It tookthem 7 hours with 2 huge front end loaders and 2 large 18 wheel tractor trailers. And the trailers were filledseveral 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 hadas 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 50miles of coast line were flattened, the bridges on I-10 from New Orleans to Slidellwere 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, over100 miles from the coast. The strength of the storm didn't surprise me. Thebreadth of it surprised everyone. It is almost 80 miles from New Orleans toOcean 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 localroads reading "Thanks, Y'all". I want to echo that for all of the prayers and help we have received here fromall 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 WebWhisperswhen we opened the "automated" email list (ListServ) in Februaryof 1998 with about 124 participants (100 laryngectomees/caregiversand 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 membersthroughout North America and abroad with an additional 50 medical & medicalsupport personnel - for a total of about 266. Of these, 206 (95%) participated on ourMail List.

Now, seven years later, after adding members and also losing some membersthrough "passing on", other illnesses, invalid Email addresses, individual choices,etc., we now have grown to approximately 1,160+ laryngectomee-caregiver membersand about 227 medical/medical support and vendor members worldwide - for a totalnow 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 thelaryngectomee 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 youfinancial hardships.

Your "FICO" is your three-digit credit score, between 300 and 850, and named afterthe company that created it, Fair Isaac Corporation. Lenders use this score todetermine 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 whetherto approve your credit application, whether to increase your credit limit, and how totreat you if you make a very late payment. Your FICO score is not determined byyour age or income, but rather by your past use of credit, as recorded by agencieslike Experian, TransUnion, and Equifax. Some say up to 80% of agency credit reportscontain errors. To make sure YOUR credit report is accurate, you can now order aFREE annual copy from each agency (just go to: http://www.annualcreditreport.com/).

To illustrate the importance of your "FICO", an October 2005 survey by "ParadeMagazine" revealed a snapshot of what borrowers with varying credit scoresnationwide 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 scoreeligible for this loan was a whopping $478.00 a month, or $5,756.00 a year - whichadded 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

You can find out YOUR "FICO" score at: http://www.myfico.com/ (but it is NOT free,there is a minimum $14.95 fee to use their software to get your FICO score and ONEcredit report). To find out what different loans will cost you, depending upon yourcredit score and what state you live in, you can also go to that web site and use theLoan Calculator provided there. Hope this helps!

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

ANSWER: Yes, it's true. In an effort to snare counterfeiters, the US government haspersuaded some color laser printer manufacturers to encode each page withidentifying information. The EFF (Electronic Frontier Foundation) has recently provenwhat many have suspected for a long time - that at least some laser printers embed asecret machine identification code on every page they print, which reveals when thepage was printed, and the serial number of the printer on which it was printed. Youmight not think it's a big deal that your printer's serial number is embedded on everypage. 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 thosecounterfeiters!! :-) .

http://www.annualcreditreport.com/

http://www.myfico.com/



ListServ "Flame Warriors"

Terms of Importanceflame 1. n. A hostile, often unprovoked, message directed at a participant of an internet discussion forum. Thecontent of the message typically disparages the intelligence, sanity, behavior, knowledge, character, orancestry 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-hofrom one forum, however, it is not unusual for them to seek each other out in other forums torenew their "fencing."

Above courtesy of Mike ReedSee 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 toWebWhispers! There is much information to be gained from the site and from

http://redwing.hutman.net/~mreed/



suggestions submitted by our members on the Email lists. If you have anyquestions or constructive criticism please contact Pat or Dutch [email protected].

Take care and stay well!Murray Allan, WW President

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

Anthony BalickiBriarcliff Manor, NY

Deborah BerwickHackberry, LA

David BishopBrighton, MI

Donald BlairWestland, MI

Jack Briner - CaregiverSummerville, SC

Nora Criswell - CaregiverLoganville, GA

Mary Decoite - CaregiverDiscovery Bay, CA

Eric Dolinger - SLPNewark, DE

Richard FeroNiceville, FL

Girgoriy DubovOmaha, NE

Karen Griffin - VendorTemecula, CA

Debra Hansen - CaregiverFort Myers, FL

Steven HastyLynn Haven, FL

Rosemary HauckNewberry, FL

Diane Jordan - CaregiverVirginia Beach, VA

Juanita LarraceyMachias, ME

Jerry Marler, Sr.Bossier City, LA

Steven MillsPerry, FL

Al NovakBrainerd, MN

Larry NuehringNewton, KS

Lorrie PearoBlossvale, NY

Mandy Pietropaolo - SLPCollegeville, PA

James RushtonLancaster, PA

Ananth Shenoy - Larynx Cancer PatientNoida, U.P., India

Viola May SellsNorth East, MD

Robert J. SmileyPort St. John, FL

Lawrence SmithLakewood, CO

Vanessa SmithEssex, UK

Jamie StephensCollege Station, TX

Dr. Dana Thomas - SLPDesoto, TX

Tina Wilkie - SLP Newcastle, NSW, Australia

Diane E. Williams Melbourne, Vic., Australia

John WozniakPunta 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: [email protected]

Disclaimers:

mailto:[email protected]



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 articlesin 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 Clubis eligible to receive tax-deductible contributions in accordance with IRS § 170.

? 2005 WebWhispersReprinting/Copying Instructions

can be found on ourWotW/Journal Page.

http://www.webwhispers.org/pages/Journal.htm

Whispers on the Web - November 2005 · attache', a narrator, teacher, emcee for various events, and...

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